Severe acroischemic injuries in the context of covid-19 casuistry

Abstract

Introduction: since the beginning of the pandemic declared in March 2020 by the World Health Organization, the skin is not excluded from this affectation, initially described as a rare finding, currently it is estimated that 20% of patients with COVID-19 present some type of dermatological manifestation that manifests itself during the acute phase of the disease or during convalescence. Skin lesions are diverse, among them acroischemic ones are striking for their importance and severity.
Objective: to describe the demographic, clinical, laboratory and evolutionary characteristics of 6 cases of COVID-19 with severe acroischemic lesions.
Methodology: Retrospective, descriptive and observational study of COVID-19 cases confirmed by laboratory tests with severe acroischemic lesions consulted in the “Servicio de Dermatología” del “Hospital Nacional” or the private practice in the period July 2020 to July 2021.
Results: 6 cases were analyzed, 3 women and 3 men, with an average age of 61,6 years, all with a confirmed diagnosis of COVID-19. The clinical patterns of acroischemic lesions observed were 2 severe microcirculatory ischemia and 4 dry gangrene. All patients had some comorbidity and elevated D-dimer. One received outpatient treatment, 4 in the inpatient ward and 1 in the intensive care unit.
All received anticoagulation. The evolution was satisfactory in 2 of them, in 2 it was necessary the partial or total amputation of the affected limbs and 1 died.
Conclusion: acroischemic skin lesions in patients with or who have had COVID-19 are rare, generally occur in older people, and are associated with a worse prognosis in terms of morbidity and mortality.