Dermatologic Manifestation of Acro-Ischemia Associated With COVID-19.

Background: The common dermatologic manifestations seen in patients with coronavirus disease 2019 (COVID-19) include morbilliform, pernio-like, urticarial, macular erythematous, vesicular, and papulosquamous disorders, as well as retiform purpura. Although cases of acro-ischemia have been demonstrated, they are not well studied or reported. Case Report: A 73-year-old male was admitted for acute hypoxic respiratory failure secondary to COVID-19 infection. During the patient's hospital course, his oxygen requirement progressively increased, and he developed painful, violaceous purpura on his right lower extremity digits. The patient was treated with therapeutic doses of enoxaparin and nitroglycerin ointment in the hospital and apixaban on discharge. The patient was lost to follow-up. Conclusion: The multiorgan dysfunction associated with COVID-19 includes dermatologic manifestations. This case illustrates that acro-ischemia can resolve with guideline-based medical treatment.

Rare Cardiac Papillary Fibroelastoma: Right Atrial, Non-Valvular, Large, Symptomatic With Pulmonary Embolism.

INTRODUCTION: Primary cardiac tumors are rarely seen in the general population and only a subset are classified as cardiac papillary fibroelastoma. CASE PRESENTATION: A 59-year-old female that presented for unresponsiveness and cardiac arrest required 4 rounds of cardiopulmonary resuscitation and intubation. Laboratory investigations showed uncompensated respiratory acidosis, hyperkalemia, and elevated troponins. A chest computed tomography angiogram illustrated an acute right pulmonary embolism and a right atrial filling defect. Furthermore, an echocardiogram demonstrated a normal ejection fraction and a large, pedunculated, mobile, and non-valvular echodensity that was attached to the right atrium endocardium. Therefore, the patient was started on a heparin infusion and catheter-directed thrombolysis; however, the mass persisted. A surgical excision was performed, and a 40 mm was removed. The patient was diagnosed with a papillary fibroelastoma based on the clinical symptoms, imaging, and histological findings. CONCLUSION: This patient's papillary fibroelastoma had multiple rare features including right atrial origin, large size, non-valvular location, and developed symptoms. Although this disease can be initially fatal, the patients typically have a favorable prognosis after a successful excision.