COVID-19 coagulopathy related gangrene

ABSTRACT

Background: SARS -COV-2 has presented with varied symptoms and a number of factors determine clinical outcome. While hypoxemic respiratory failure remains main cause of morbidity and mortality, a hyperinflammatory state induced endothelial injury and hypercoagulability leading to thromboembolism also is a leading cause of mortality. Case Sudy A 60-year-old diabetic, hypertensive, nonsmoker, male presented with complaints of cough, fever and breathlessness since 3 days. Patient presented with tachypnea and maintaining saturation of 85% on room air, CT severity score was 13/25. Patient was treated in ICU with Noninvasive ventilation, prophylactic Enoxaparin, Remdesivir and steroids. Patient's respiratory status was deteriorating and was intubated, kept on mechanical ventilator and later tracheostomy was done. During the course of illness patient developed pain over right foot which progressed to gangrene and ischemia over left foot .CT- Aortogram done showed complete occlusion of infra-renal abdominal aorta. Discussion: Patient developed progressive elevation of D-dimer even after thromboprophylaxis with enoxaparin. However gangrene progression was irreversible once set in, even though patient was switched over to high dose anticoagulants, with antiplatelet along with Phosphodiesterase inhibitor, implying that high degree of coagulation cascade disruption is potentially irreversible. Conclusion: To start increased dose of initial thromboprophylaxis in patient with high CT severity.