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A case of rapidly progressive upper limb ischemic necrosis in a patient with COVID-19
Kamal Makhoul1, Yousef Shukha1, Lana Abu Hanna1
1Internal Medicine E and Keter B Departments, Rambam Health Care Campus, Haifa, Israel.
Insights
This case report details a COVID-19 patient who experienced upper limb ischemia leading to amputation. It highlights the critical need for vigilant monitoring and anticoagulant therapy in severe acute respiratory syndrome coronavirus 2 patients.
Area of Science:
- Vascular Surgery
- Infectious Diseases
- Critical Care Medicine
Background:
- The COVID-19 pandemic, caused by SARS-CoV-2, presents with multisystemic involvement and significant mortality, primarily due to respiratory complications.
- While thromboembolic events are known COVID-19 complications, leading to lower limb amputations, upper limb involvement remains less documented.
Observation:
- A novel case of a COVID-19 patient presenting with severe upper limb ischemia is described.
- The condition rapidly progressed to hand necrosis, necessitating urgent, extensive amputation of the affected upper limb.
Findings:
- This case represents the first reported instance of urgent upper limb amputation in a patient with COVID-19.
- The findings underscore the potential for severe vascular complications beyond the respiratory system in COVID-19 patients.
Implications:
- The case highlights the critical importance of considering thromboembolic sequelae in COVID-19 patients, even in the upper extremities.
- It emphasizes the necessity of prompt diagnosis, aggressive anticoagulant therapy, and heightened clinical awareness to prevent devastating outcomes like limb loss.
Background:
For more than a year, health systems all over the world have been combating the global coronavirus disease 2019 (COVID-19) pandemic, caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The disease was first described in the city of Wuhan in China, presenting as an atypical infection of the lower respiratory tract.
Methods:
COVID-19 is characterized by multisystemic involvement, and mortality is attributed mainly to the respiratory system involvement, which may lead to severe acute respiratory distress syndrome and respiratory failure. Several COVID-19-associated complications are being increasingly reported, including arterial and venous thromboembolic events that may lead to amputation of the affected limbs. So far, a large number of reports have described hypercoagulability crises leading to amputation of the lower limbs. However, a search of the National Library of Medicine (MEDLINE) revealed no cases of urgent upper limb amputation in COVID-19 patients.
Results:
This article describes a novel case of upper limb ischemia in a COVID-19 patient, with rapid progression to hand necrosis, requiring urgent through-arm amputation of the upper limb.
Conclusions:
This case emphasizes the need for anticoagulant therapy in COVID-19 patients and to maintain a constant awareness of the possible thromboembolic COVID-19-related sequelae.
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