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Case Reports
. 2022 Dec 27;10(12):e6790.
doi: 10.1002/ccr3.6790. eCollection 2022 Dec.

COVID-associated non-vasculitic thrombotic retiform purpura of the face and extremities: A case report

Connor M Bunch  1 , Nuha Zackariya  2 , Anthony V Thomas  2 , Jack H Langford  3 , Michael Aboukhaled  3 , Samuel J Thomas  3 , Aida Ansari  3 , Shivani S Patel  3 , Hallie Buckner  3 , Joseph B Miller  1 , Christy L Annis  3 , Margaret A Quate-Operacz  4 , Leslie A Schmitz  4 , Joseph J Pulvirenti  5 , Jonathan C Konopinski  6 , Kathleen M Kelley  7 , Samer Hassna  8 , Luke G Nelligan  9 , Mark M Walsh  3
Affiliations
Case Reports

COVID-associated non-vasculitic thrombotic retiform purpura of the face and extremities: A case report

Connor M Bunch et al. Clin Case Rep. .

Abstract

SARS-CoV-2 infection can manifest many rashes. However, thrombotic retiform purpura rarely occurs during COVID-19 illness. Aggressive anti-COVID-19 therapy with a high-dose steroid regimen led to rapid recovery. This immunothrombotic phenomenon likely represents a poor type 1 interferon response and complement activation on the endothelial surface in response to acute infection.

Keywords: COVID‐19; SARS‐CoV‐2; acral lesions; chilblains; exanthema; purpura; vasculitis.

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Conflict of interest statement

There are no sources of financial support in the form of grants, equipment, or pharmaceuticals for this report. Mark M. Walsh is on the Speakers Bureau of Alexion Pharmaceuticals. The other authors report no conflicts of interest.

Figures

FIGURE 1
FIGURE 1
Case timeline summary of COVID‐associated nonvasculitic thrombotic retiform purpura. Created with BioRender.com.
FIGURE 2
FIGURE 2
Top Row: Clinical images from the day of presentation showing purplish patches on the face, bilateral hands, forearms, feet, and legs. Middle Row: Clinical images from the third day of admission showing worsening purpura. Bottom Row: Images 6 weeks after index presentation demonstrating complete resolution of the rash.
FIGURE 3
FIGURE 3
Punch biopsy of right dorsal forearm, hematoxylin & eosin stain, 200× magnification. There is occlusion of postcapillary venules in the superficial dermis by platelet‐fibrin thrombi. This is associated with red blood cell extravasation. No associated vasculitis is present.
FIGURE 4
FIGURE 4
Venn diagram comparing the salient features of the “COVID toes” rash and COVID‐associated thrombotic retiform purpura., , , Created with BioRender.com. BMI, body mass index; CRP, C‐reactive protein; IF, immunofluorescence; IFN, interferon; INR, international normalized ratio; PCR, polymerase chain reaction; PT, prothrombin time
See this image and copyright information in PMC

References

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