A Fatal Case of COVID-19 with Diffuse Leukocytoclastic Vasculitis of Both Hips, Breasts, Feet, and Back

Abstract

A 47-year-old female patient with no known disease other than rheumatoid arthritis in remission was admitted to the hospital with complaints of bruising on her feet, breasts, hips, and back. It was determined that her severe acute respiratory syndrome coronavirus-2 polymerase chain reaction test was positive 7 days ago and she received favipiravir treatment for 5 days. In the physical examination, ecchymotic lesions were detected in her both feet, breasts, trochanteric regions, and posterior thoracic regions, which were symmetrical and did not change color with pressure in varying sizes. There were diffuse bilateral ground glass and consolidation areas in the computed tomography of the lungs. Because of the histopathological examination of the biopsy taken from the skin lesions, the patient was diagnosed with leukocytoclastic vasculitis. In the lower extremity venous Doppler ultrasonography examination, there was complete occlusion due to thrombus in the subacute period in the right vena saphena parva. During the subsequent intensive care follow-up period, necrotic lesions progressed to amputation in the right foot, debridement in the left foot, and trochanteric regions, and bilateral mastectomy. Our patient required multidisciplinary management involving many specialties during her long-term stay in the intensive care unit. Here, we present a case of coronavirus disease-2019 leading to severe and diffuse leukocytoclastic vasculitis resulting in amputation.

Keywords

• coagulopathy
• leukocytoclastic vasculitis
• covid-19
• amputation