ABSTRACT
With the onset of the SARS-CoV-2 pandemic, Kawasaki Disease (KD) has come to the fore with its many atypical manifestations. Atypical clinical neurological, ophthalmological, musculoskeletal, gastrointestinal and pulmonary manifestations in a febrile child with raised markers should prompt the clinician to think of Kawasaki disease. Peripheral gangrene is a rare atypical manifestation of KD reported in infancy. We present a three-and-a-half-year-old boy with extensive gangrene all four limbs and face along with purpura fulminans. He was successfully treated with two doses of intravenous immunoglobulin (IVIG) and infliximab, with no residual gangrene. This case highlights that very severe forms of Kawasaki disease require IVIG, pulse steroids as well as infliximab for adequate control and complete resolution of the disease.
Subject(s)
COVID-19 , Mucocutaneous Lymph Node Syndrome , COVID-19/complications , Child, Preschool , Gangrene/diagnosis , Gangrene/etiology , Humans , Immunoglobulins, Intravenous/therapeutic use , Infliximab/therapeutic use , Male , Mucocutaneous Lymph Node Syndrome/complications , Mucocutaneous Lymph Node Syndrome/diagnosis , Mucocutaneous Lymph Node Syndrome/drug therapy , SARS-CoV-2ABSTRACT
BACKGROUND AND AIMS: The novel coronavirus disease (COVID-19) caused by SARS-CoV-2 has turned the world topsy-turvy since its onset in 2019. The thromboinflammatory complications of this disease are common in critically ill patients and associated with poor prognosis. Symmetrical peripheral gangrene (SPG) is characterized by symmetrical distal gangrene in absence of any large vessel occlusion or vasculitis and it is usually associated with critical illness. Our aim was to report the clinical profile and outcome of patients diagnosed with SPG associated with COVID-19. To the best of our knowledge, no such similar cases have been reported till date. METHODS: In this case series, we have discussed the clinical presentation, laboratory parameters and outcome in a series of two patients of SPG associated with COVID-19 and also compared those findings. Due to paucity of data, we also reviewed the literature on this under-diagnosed and rarely reported condition and association. RESULTS: Two consecutive patients (both males, age range: 37-42 years, mean: 39.5 years) were admitted with the diagnosis of COVID-19 associated SPG. Both patients had clinical and laboratory evidence of disseminated intravascular coagulation (DIC). Leucopenia was noted in both patients. Despite vigorous therapy, both patients succumbed to their illness within a fortnight of admission. CONCLUSION: SPG in the background of COVID-19 portends a fatal outcome. Physicians should be aware of its grim prognosis.
Subject(s)
COVID-19/complications , Gangrene/etiology , Adult , COVID-19/diagnosis , Critical Illness , Disseminated Intravascular Coagulation/diagnosis , Disseminated Intravascular Coagulation/virology , Fatal Outcome , Gangrene/diagnosis , Humans , India , Leukopenia/diagnosis , Leukopenia/virology , Male , Prognosis , SARS-CoV-2/pathogenicity , Severe Acute Respiratory Syndrome/diagnosis , Severe Acute Respiratory Syndrome/virologyABSTRACT
AIMS: Identify the prevalence, risk factors and outcomes of lower extremity ischemic complications. METHODS: A systematic review was conducted by searching PubMed and SCOPUS databases for SARS-CoV-2, COVID-19 and peripheral arterial complications. RESULTS: Overall 476 articles were retrieved and 31 articles describing 133 patients were included. The mean age was 65.4 years. Pain and gangrene were the most common presentation. Hypertension (51.3%), diabetes (31.9%) and hypercholesterolemia (17.6%) were associated co-morbidities. Overall, 30.1% of patients died and amputation was required in 11.8% patients. CONCLUSIONS: COVID-19 patients with diabetes or hypertension are susceptible for lower limb complications and require therapeutic anti-coagulation.
Subject(s)
COVID-19 , Diabetic Angiopathies , Hypertension , Aged , Amputation, Surgical/statistics & numerical data , COVID-19/complications , COVID-19/diagnosis , COVID-19/epidemiology , COVID-19/therapy , Comorbidity , Diabetes Mellitus/diagnosis , Diabetes Mellitus/epidemiology , Diabetes Mellitus/therapy , Diabetic Angiopathies/complications , Diabetic Angiopathies/diagnosis , Diabetic Angiopathies/epidemiology , Diabetic Angiopathies/therapy , Female , Gangrene/diagnosis , Gangrene/epidemiology , Gangrene/etiology , Gangrene/therapy , Humans , Hypertension/complications , Hypertension/diagnosis , Hypertension/epidemiology , Hypertension/therapy , Lower Extremity , Male , Middle Aged , Peripheral Arterial Disease/diagnosis , Peripheral Arterial Disease/epidemiology , Peripheral Arterial Disease/etiology , Peripheral Arterial Disease/therapy , Prevalence , Prognosis , Risk Factors , SARS-CoV-2/physiologyABSTRACT
At the onset of the COVID-19 crisis, a 63-year-old woman with multiple life-limiting comorbidities was referred with a necrotic infected left breast mass on a background of breast cancer treated with conservation surgery and radiotherapy 22 years previously. The clinical diagnosis was locally advanced breast cancer, but four separate biopsies were non-diagnostic. Deteriorating renal function and incipient sepsis and endocarditis resulted in urgent salvage mastectomy during the peak of the COVID19 pandemic. The final diagnosis was infected ischaemic/infarcted breast (wet gangrene) secondary to vascular insufficiency related to diabetes, cardiac revascularisation surgery and breast radiotherapy.
Subject(s)
Anti-Bacterial Agents/therapeutic use , Breast/surgery , Diabetic Angiopathies/therapy , Enterobacteriaceae Infections/therapy , Gangrene/therapy , Mastectomy/methods , Mastitis/therapy , Negative-Pressure Wound Therapy/methods , Breast/blood supply , Breast Neoplasms/diagnosis , COVID-19 , Carcinoma, Ductal, Breast/diagnosis , Coronary Artery Bypass , Debridement/methods , Diabetes Mellitus, Type 2/complications , Diabetic Angiopathies/diagnosis , Diabetic Angiopathies/etiology , Diagnosis, Differential , Enterobacteriaceae Infections/diagnosis , Female , Gangrene/diagnosis , Humans , Infarction , Mammary Arteries/surgery , Mastectomy, Segmental , Mastitis/diagnosis , Middle Aged , Morganella morganii , Neoplasm Recurrence, Local/diagnosis , Radiotherapy , SARS-CoV-2 , Salvage TherapyABSTRACT
A 12-year-old girl with severe acute respiratory syndrome coronavirus 2 infection presented as phlegmasia cerulea dolens with venous gangrene. Emergent mechanical thrombectomy was complicated by a massive pulmonary embolism and cardiac arrest, for which extracorporeal cardiopulmonary resuscitation and therapeutic hypothermia were used. Staged ultrasound-assisted catheter-directed thrombolysis was used for treatment of bilateral pulmonary emboli and the extensive lower extremity deep vein thrombosis while the patient received extracorporeal membrane oxygenation support. We highlight the need for heightened suspicion for occult severe acute respiratory syndrome coronavirus 2 infection among children presenting with unusual thrombotic complications.
Subject(s)
COVID-19/diagnosis , Pulmonary Embolism/virology , Thrombophlebitis/virology , Veins/pathology , Venous Thrombosis/virology , COVID-19/complications , COVID-19/pathology , COVID-19/therapy , Child , Female , Gangrene/diagnosis , Gangrene/virology , Humans , Pulmonary Embolism/diagnosis , Pulmonary Embolism/pathology , Pulmonary Embolism/therapy , Thrombophlebitis/diagnosis , Thrombophlebitis/pathology , Thrombophlebitis/therapy , Venous Thrombosis/diagnosis , Venous Thrombosis/pathology , Venous Thrombosis/therapyABSTRACT
OBJECTIVE: Coronavirus disease 2019 (COVID-19) related coagulopathy may be the first clinical manifestation even in non-vasculopathic patients and is often associated with worse clinical outcomes. CASE PRESENTATION: A 78 years old woman was admitted to the Emergency Unit with respiratory symptoms, confusion and cyanosis at the extremity, in particular at the nose area, hands and feet fingers. A nasal swab for COVID-19 was performed, which resulted positive, and so therapy with doxycycline, hydroxychloroquine and antiviral agents was started. At admission, the patient was hemodynamically unstable requiring circulatory support with liquids and norepinephrine; laboratory tests showed disseminated intravascular coagulation (DIC). During hospitalization, the clinical condition worsened and the cyanosis of the nose, fingers, and toes rapidly increased and became dried gangrene in three days. Subsequently, the neurological state deteriorated into a coma and the patient died. DISCUSSION: In severe cases, COVID-19 could be complicated by acute respiratory disease syndrome, septic shock, and multi-organ failure. This case report shows the quick development of dried gangrene in a non-vasculopathic patient, as a consequence of COVID-19's coagulopathy and DIC. CONCLUSIONS: In our patient, COVID-19 related coagulopathy was associated with poor prognosis.