Ecchymosis in critical coronavirus disease 2019 (COVID-19) patient in Tangerang, Indonesia: a case report
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Ecchymosis in critical coronavirus disease 2019 (COVID-19) patient in Tangerang, Indonesia: a case report Allen Widysanto1 · T. D. Wahyuni1 · L. H. Simanjuntak1 · S. Sunarso1 · S. S. Siahaan1 · H. Haryanto1 · C. O. Pandrya1 · R. C. A. Aritonang1 · C. Gunawan2 · Angela1 Accepted: 9 November 2020 © Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract We have read with great interest the articles regarding cutaneous manifestations in Coronavirus Disease 2019 (COVID-19) infection. Studies showed 20.4% of COVID-19 patients developed cutaneous manifestations. COVID-19 causes vascular endothelial injury, vasculitis and prothrombotic state which might be the underlying cause of hemorrhagic cutaneous manifestations, disseminated intravascular coagulation (DIC), and multiple organ failures. To date, hemorrhagic cutaneous manifestations reported are chilblain-like lesion, purpura to ecchymosis, livedo reticularis, and dry gangrene. We present a case of ecchymosis in COVID-19-positive ICU hospitalized patient. Keywords COVID-19 · Cutaneous manifestation · DIC · Ecchymosis · Vasculopathy
Highlights • Coronavirus Disease 2019 (COVID-19) is associated
with vasculitis and prothrombotic state.
• Non-critical and critically ill COVID-19 patients might
developed bleeding cutaneous manifestations such as purpura or ecchymosis. • The pathophysiology of ecchymosis in COVID-19 might be caused by microvascular injury and thrombosis, vasculitis, and disseminated intravascular coagulation (DIC). • Secondary antiphospholipid syndrome (APS) might presented in critical COVID-19 patients. • The presence of ecchymosis in COVID-19 patients is indicating an occuring coagulopathy and associated with increased mortality in COVID-19 infection.
* Allen Widysanto [email protected] 1
Siloam Hospitals Kelapa Dua, Tangerang, Indonesia
Faculty of Medicine, Pelita Harapan University, Tangerang, Indonesia
2
Introduction Coronavirus Disease 2019 (COVID-19) is a public health emergency of international concern, including in Indonesia. Studies showed COVID-19 causes vasculitis and prothrombotic state which might be the underlying cause of some cutaneous manifestations such as purpuric rash and livedo reticularis, DIC, and multiple organ failures [1–3].We would like to report a case of ecchymosis in COVID-19-positive ICU hospitalized patient from Indonesia.
Case A 69-years-old male patient was admitted to our hospital on March 23, 2020 with presenting symptoms after trip abroad including fever of 11 days, cough, dyspnea, and headache. The patient has history of hypertension on therapy. The vital signs and physical examinations were as follows: blood pressure 130/70 mmHg, pulse rate 91/minute, respiratory rate 23/min, temperature 37.2 °C, SpO2 96% on O2 3 liter per min (lpm) via nasal cannula(NC), and ronchi were found on bibasal lung fields. Chest CT scan showed mixed typed diffuse ground glass opacity and multifocal crazy paving pattern involving both lungs, predominantly in peripheral, thick-walled septated cav
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