Ischemic stroke and purpuric dermatitis as COVID-19-related complications in a peritoneal dialysis patient
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CASE REPORT
Ischemic stroke and purpuric dermatitis as COVID‑19‑related complications in a peritoneal dialysis patient Alberto de Lorenzo Alvarez1 · Ángela Revilla2 · Teresa Corbalán3 · Ana Villar4 · Laura Espinel1 · Judith Martins1 · Alfonso Cubas1 Received: 20 July 2020 / Accepted: 31 October 2020 © Japanese Society of Nephrology 2020
Abstract Patients on dialysis may have an elevated risk of severe coronavirus disease 2019 (COVID-19) and its complications due to their high prevalence of comorbidities. Here we describe the case of an 80-year-old male undergoing peritoneal dialysis with a moderate SARS-CoV-2 infection who developed a purpuric dermatitis and ischemic stroke after successful recovery from his bilateral pneumonia. Erythemato-papular lesions affecting trunk and lower limbs appeared 17 days after the onset of SARS-CoV-2 symptoms. These kind of lesions are an infrequent cutaneous manifestation of COVID-19. The pathology revealed a moderate purpuric dermatitis affecting superficial dermis and corticoesteroids were prescribed achieving complete resolution. Arterial thrombosis affecting cerebellar vermis emerged 30 days after the onset of COVID-19 symptoms. It occurred 5 days after withdrawal of antithrombotic prophylaxis that the patient received from his admission until 2 weeks after discharge. He completely recovered from his paresis and continued on his regular antiaggregation therapy. This is the first case report published of a patient with PD with such COVID-19-related complications. More experience is needed to determine the appropriate length of antithrombotic prophylaxis especially in high-risk individuals. Keywords Coronavirus disease 19 · Complications · Cardiovascular risk · Peritoneal dialysis · End-stage renal disease
Introduction Since firsts cases in December 2019, acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has killed over 1,000,000 people all around the world. Patients on chronic dialysis are likely to be at increased risk of COVID-19 and its complications [1, 2]. A matter of great interest is the wide spectrum of infection symptomatology and disease manifestation, ranging from asymptomatic carriers, life-threatening acute respiratory distress syndrome, multi-organ failure and death [3]. There are a number of emerging complications * Alberto de Lorenzo Alvarez [email protected] 1
Department of Nephrology, Hospital Universitario de Getafe, Carr. Madrid‑Toledo, Km 12,500, Getafe, 28905 Madrid, Spain
2
Primary Care Center El Greco, Getafe, Madrid, Spain
3
Department of Radiology, Hospital Universitario de Getafe, Madrid, Spain
4
Department of Pathology, Hospital Universitario de Getafe, Madrid, Spain
of the COVID-19 pandemic such as dermatologic impairment and ischemic stroke considered potentially lethal as the latter. Although the precise incidence of stroke in these patients is not known, some authors describe an incidence between 2.5 and 5% [1–4]. Cutaneous manifestations in infected patients are beginning to emerge from around the world.
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