Cutaneous Vasculopathy in a COVID-19 Critically Ill Patient: A Histologic, Immunohistochemical, and Electron Microscopy Study. (7th April 2021)

• Record Type: Journal Article
• Authors: Kyriakoudi, Anna; Pontikis, Konstantinos; Tsaraklis, Athanasios; Soura, Efthymia; Vourlakou, Christine; Kossyvakis, Athanasios; Potamianou, Efstathia; Kaniaris, Evangelos; Ioannidou, Iliana; Mentis, Andreas; Kloukina, Ismini; Daganou, Maria; Koutsoukou, Antonia
• Other Names: Lazzeri Chiara Academic Editor.
• Is Part Of: Case reports in critical care. Volume 2021(2021)
• Publication Date: 2021-04-07
• Subjects: Critical care medicine -- Periodicals; Emergency medicine -- Periodicals; Medical emergencies -- Periodicals; 616.02805
• DOI: 10.1155/2021/6644853
• Languages: English
• ISSNs: 2090-6420

Abstract

Abstract : 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.