Covid19 toe, a late manifestation of mild SARS-CoV-2 with Diabetes

ABSTRACT

Background: SARS-CoV-2 may present with symptoms, coughing, fever, weakness, and breathlessness. Other common symptoms are discoloring skin, rashes or toes color changes, swelling, present with pain, and some individuals without pain. Some researchers think that these rashes are due to respiratory tract infection, which invades the peripheral skin. It has no relation with the Raynaud phenomena because of the periphery's coldness, stress, or ischemia and low blood supply to a region affected. Aim: No all the Patients with Covid-19 toes are favorable for the Covid-19 testing, and some develop covid-19 toes after the symptoms of covid-19 have subsided;therefore, it grows in the different stages of covid-19 infection and not necessarily reflected inactive phases of the covid-19 disease. On the other hand, many patients with Covid-19 toes do not have severe symptoms but mild congestion and fever at a younger age, leading to kolviras et al. to propose a mechanism for antiviral response mediated by more immature immune cells. Method: The Covid-19 toe primarily presents moderate to severe levels in half of the cases, which show damage to vessels and leaking of blood, which directly links to inflammation. However, even when inflammation was mild, there was evidence of damage to the vasculature and leaking. We do not know much about the cause of Covid-19 toe. Still, some researchers suggested coagulation pathways and various interferons might be responsible. Others say viral particles may lead to immune cells proliferating and cause the bursting of covid-19 toes. The findings of SARS-CoV-2 on endothelial cells of a skin lesion by immunohistochemistry show the pathophysiology of COVID-19. Results: Patient-reported on 20 July 2020 developed mild symptoms of Covid-19 with mild fever, dry cough, smell loss nearly wholly, and headache for four days;RTPCR for SARS-CoV-2%25 were positive. The patient had a history of diabetes for 10 years, without hypertension, or any chronic disease. Pt received Vavipiravir 3.6 gm in 14 days, Ivermectin 12 mg once a day for five days, along with VitD3 60,000 IU, Doxycycline for seven days. After three days of starting antiviral drugs favipiravir, the symptoms were relieved, and fever subsided after five days. Patients developed reddish discoloration of great right toes after one month of symptoms with involvement of almost two-thirds of the toe with no pain or any pus formation (fig 1). It took eleven months to grow a new nail and replace most dark red discoloration, still, a broken nail at the upper margin. [Formula presented] Discussion: It's not a common manifestation of covid-19 infection. It may last from weeks to months, and some may not require treatment except for some with topical steroids. In this patient involvement of a single toe started after one month of infection and partial recovery of new growth of nail took 11 months which shows even in mild covid19 infection peripheral vascular complication may manifest after the infection subsided and may continue even after one year of post covid19. Therefore we need to keep watch and screen all the post covid19 patients.