Acute limb ischemia as sole initial manifestation of SARS-CoV-2 infection

Abstract

We present the case of a patient with acute upper limb ischemia as the sole initial manifestation of severe acute respiratory syndrome associated with coronavirus disease 2 infection, without concomitant respiratory symptoms or pneumonia. Viral infection presumably precipitated the patient's thromboembolic event, causing multifocal vascular occlusions. This case illustrates that coronavirus disease-19 must be considered in the differential diagnosis of patients presenting with signs or symptoms of coagulopathy, even in the absence of respiratory symptoms. We believe that an awareness of the variety of clinical presentations in patients with coronavirus disease-19, particularly extrapulmonary manifestations, is critical for optimal patient management as well as implementation of appropriate infection prevention measures.

Keywords: Arterial thrombosis; COVID-19; Coagulopathy; Limb ischemia; SARS-CoV-2.

Fig

Multifocal vascular occlusions. Computed tomography angiogram of the right upper extremity demonstrating a large thrombus in the proximal right subclavian artery immediately distal to the origin of the common carotid artery (left), as well as complete occlusion of the right ulnar artery in the antecubital fossa and extending to the hand (right).