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Development of sacral/buttock retiform purpura as an ominous presenting sign of COVID-19 and clinical and histopathologic evolution during severe disease course.
McBride, Jeffrey D; Narang, Jatin; Simonds, Robert; Agrawal, Shruti; Rodriguez, E Rene; Tan, Carmela D; Baldwin, William M; Dvorina, Nina; Krywanczyk, Alison R; Fernandez, Anthony P.
  • McBride JD; Department of Dermatology, Cleveland Clinic, Cleveland, Ohio, USA.
  • Narang J; Department of Pathology, Cleveland Clinic, Cleveland, Ohio, USA.
  • Simonds R; Cleveland Clinic Lerner College of Medicine, Cleveland, Ohio, USA.
  • Agrawal S; Department of Dermatology, Cleveland Clinic, Cleveland, Ohio, USA.
  • Rodriguez ER; Department of Dermatology, Cleveland Clinic, Cleveland, Ohio, USA.
  • Tan CD; Department of Pathology, Cleveland Clinic, Cleveland, Ohio, USA.
  • Baldwin WM; Department of Pathology, Cleveland Clinic, Cleveland, Ohio, USA.
  • Dvorina N; Department of Inflammation and Immunity, Cleveland Clinic Lerner Research Institute, Cleveland, Ohio, USA.
  • Krywanczyk AR; Department of Inflammation and Immunity, Cleveland Clinic Lerner Research Institute, Cleveland, Ohio, USA.
  • Fernandez AP; Department of Pathology, Cleveland Clinic, Cleveland, Ohio, USA.
J Cutan Pathol ; 48(9): 1166-1172, 2021 Sep.
Article in English | MEDLINE | ID: covidwho-1208906
ABSTRACT
Retiform purpura has been described as a relatively frequent cutaneous finding in patients with coronavirus disease 2019 (COVID-19). The etiology is hypothesized to be related to thrombotic vasculopathy based on lesional biopsy specimen findings, but the pathogenesis of the vasculopathy is not completely understood. Here, we present a case of a retiform purpuric patch on the sacrum/buttocks in a hospitalized patient prior to subsequent diagnosis of COVID-19 and an eventual fatal disease course. Two lesional biopsy specimens at different time points in the disease course revealed thrombotic vasculopathy, despite therapeutic anticoagulation. Detailed histopathologic evaluation using immunohistochemical markers suggest the etiology of the vasculopathy involves both persistent complement activation and platelet aggregation, which possibly promote ongoing thrombus formation. This case highlights that sacral/buttock retiform purpuric patches may be a presenting sign of infection with SARS-CoV-2 virus and may represent an ominous sign supporting a future severe disease course. In addition, biopsy specimen findings at separate time points demonstrate that cutaneous vasculopathy may persist despite adequate systemic anticoagulation, possibly due to the combination of persistent complement and platelet activation. Finally, occlusive thrombi in sacral/buttock retiform purpuric patches may contribute to future ulceration and significant cutaneous morbidity in patients who survive COVID-19.
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Full text: Available Collection: International databases Database: MEDLINE Main subject: Purpura / Sacrum / Buttocks / COVID-19 Type of study: Case report / Diagnostic study / Etiology study / Experimental Studies / Prognostic study Topics: Long Covid Limits: Aged / Female / Humans Language: English Journal: J Cutan Pathol Year: 2021 Document Type: Article Affiliation country: Cup.14038

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Full text: Available Collection: International databases Database: MEDLINE Main subject: Purpura / Sacrum / Buttocks / COVID-19 Type of study: Case report / Diagnostic study / Etiology study / Experimental Studies / Prognostic study Topics: Long Covid Limits: Aged / Female / Humans Language: English Journal: J Cutan Pathol Year: 2021 Document Type: Article Affiliation country: Cup.14038