A Case of Rapidly Progressive Upper Limb Ischemic Necrosis in a Patient with COVID-19

Makhoul, Kamal; Shukha, Yousef; Abu Hanna, Lana; Nitecki, Samy; Leiderman, Maxim; Hayek, Tony; Hamoud, Shadi

AIM: For more than one year the health systems all over the world are combating the global Corona virus disease 2019 (COVID-19) pandemic, cased by a novel Corona virus (N-COV) which was first described in Wuhan city, 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, among which arterial and venous thromboembolic events, that may lead to amputation of affected limbs. So far, a large number of reports have described hypercoagulability crises leading to amputation of lower limbs, while the National Library of Medicine (Medline) search revealed no cases of urgent upper limb amputation in COVID-19 patients. RESULTS: We here describe for the first time in literature, a 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: Our case emphasizes the need for anticoagulant therapy in COVID-19 patients, and keeping in mind to stay aware for the possible thromboembolic COVID-19 related sequelae.