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. 2021 Jun 30;73(1):59.
doi: 10.1186/s43044-021-00187-0.

A clinical case series of COVID-19-associated acute limb ischemia: real-world situation

Steven Philip Surya  1 , Rony Marethianto Santoso  2
Affiliations

A clinical case series of COVID-19-associated acute limb ischemia: real-world situation

Steven Philip Surya et al. Egypt Heart J. .

Abstract

Background: COVID-19 was a trending topic all year long in 2020. Currently, it is not only a problem for a pulmonologist since it could cause complications to many other organs, including the cardiovascular system. Recent acute COVID-19 infection state has been associated with hypercoagulation and causing microthrombi called immunothrombus. Acute limb ischemia is one of the rare complications but organ-threatening. Unfortunately, unlike coronary artery disease, there is no recent guideline for cardiologists to diagnose and manage acute limb ischemia in pandemic situations CASE PRESENTATION: This case series presented two patients with acute limb injury (ALI)-complicating COVID-19, with chief complaints of pain at their lower extremity. The first patient was an 80-year-old woman who was just dismissed from the hospital due to COVID-19. The distal part of her toe was cyanosed, and her motoric and sensory functions were partially reduced. She was treated with oral drug therapy due to unwillingness to be hospitalized. Interestingly, she had recovered by using oral drug therapy. The second case was a 54-years-old female with several comorbidities such as obesity, type 2 diabetes mellitus, hypertension, dyslipidemia, and chronic obstructive pulmonary disease. She had cyanosed foot and weak arterial pulsation. Unfortunately, she passed away due to acute respiratory distress syndrome.

Conclusion: Several internal and external factors cause ALI treatment to be more challenging in the pandemic COVID-19 situation. The diagnosis and management of ALI in COVID-19 patients may not fully comply with the current guideline and are likely to be affected by local hospital regulations. Clinical follow-up might be an essential feature in treating ALI in COVID-19 patients.

Keywords: Acute limb ischemia; COVID-19; COVID-19-associated coagulopathy; Case report; Immunothrombus.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Right forefoot was cyanosed, and lower leg was cold, with reduced movement of toes
Fig. 2
Fig. 2
A CT scan of the patient’s chest showing multiple honeycomb appearance and ground-glass opacity (GGO)
Fig. 3
Fig. 3
Normal flow velocity and spectrum in the common right femoral arteries (triphasic curve)
Fig. 4
Fig. 4
Four-week follow-up. Clinically improving, but the toe was still cyanosed
Fig. 5
Fig. 5
Weak pulse at posterior tibial and dorsalis pedis arteries. Cyanosed at toes
See this image and copyright information in PMC

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