COVID-19 Associated Peripheral Gangrene: A Case Series

Abstract

Patients with COVID-19 may develop venous and arterial thrombosis due to severe inflammation, cytokine storm, and diffuse intravascular coagulation, increasing mortality and morbidity. The aim was to report the clinical profile and outcome of patients diagnosed with peripheral gangrene associated with COVID-19. In this case series, we discussed the clinical presentation, laboratory parameters, and outcome in a series of three patients with peripheral gangrene associated with COVID-19 and also compared those findings. Three patients (two males and one female, age range: 50–72 years, and mean: 61.6 years) were admitted with the diagnosis of COVID-19-associated peripheral gangrene. Three patients had clinical and laboratory evidence of disseminated intravascular coagulation. Marked thrombocytopenia was noted in two patients. Despite vigorous therapy, two patients succumbed to their illness within 9–21 days of intensive care admission. D-dimer level and procalcitonin increased in all cases, while those who succumbed to death showed a marked variation in the D-dimer level from day 1 to the day of death. Prothrombin time (PT) was markedly increased in all three cases, while activated partial thromboplastin time showed little change. Amputation was done in two patients, out of which one succumbed to death. Peripheral gangrene cases in the background of COVID-19 portend a fatal outcome and need strict monitoring of the D-dimer, procalcitonin, and PT level, and a marked variation in these values could be alarming and used as a marker for predicting survival in cases of COVID-19 with peripheral gangrene and also highlighted the limited role of amputation in reducing mortality.

Keywords

• amputation
• covid-19
• gangrene