Case Reports in Critical Care (Jan 2021)

Cutaneous Vasculopathy in a COVID-19 Critically Ill Patient: A Histologic, Immunohistochemical, and Electron Microscopy Study

  • Anna Kyriakoudi,
  • Konstantinos Pontikis,
  • Athanasios Tsaraklis,
  • Efthymia Soura,
  • Christine Vourlakou,
  • Athanasios Kossyvakis,
  • Efstathia Potamianou,
  • Evangelos Kaniaris,
  • Iliana Ioannidou,
  • Andreas Mentis,
  • Ismini Kloukina,
  • Maria Daganou,
  • Antonia Koutsoukou

DOI
https://doi.org/10.1155/2021/6644853
Journal volume & issue
Vol. 2021

Abstract

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We describe a critically ill, SARS-CoV-2 positive patient with respiratory failure and thrombotic/livedoid skin lesions, appearing during the course of the disease. The biopsy of the lesions revealed an occlusive, pauci-inflammatory vasculopathy of the cutaneous small vessels characterized by complement and fibrinogen deposition on vascular walls, pointing to a thrombotic vasculopathy. Transmission electron microscopy of the affected skin failed to reveal any viral inclusions. Clinical evaluation and laboratory findings ruled out systemic coagulopathies and disseminated intravascular coagulation, drug-induced skin reaction, and common viral rashes. Our hypothesis is that the, herein evidenced, microvascular occlusive injury might constitute a significant pathologic mechanism in COVID-19, being a common denominator between cutaneous and pulmonary manifestations.