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.
Coronavirus disease 2019 (COVID-19) is a worldwide pandemic that had emerged in China since December 2019. The disease affects all age groups, with clinical manifestations in the spectrum from asymptomatic to rapidly lethal multi-organ failure, mainly involving the respiratory system. Diagnosis is confirmed mainly by a positive real-time polymerase chain reaction (PCR) nasopharyngeal swab. It is highly recommended to avoid performing invasive procedures in COVID-19 subjects to prevent the potential for dissemination of the pathogen. Treatment consists in particular of respiratory support and symptom relief. Dexamethasone is widely used with encouraging response. There were no cases in the literature that were diagnosed with positive reverse transcription-polymerase chain reaction (RT-PCR) testing only from fluid of involved organs, while repeated nasopharyngeal swabs returned negative for COVID-19. We here describe a case of COVID-19 that presented with moderate-severe pulmonary involvement, diagnosed by RT-PCR testing from bronchoalveolar lavage, while several nasopharyngeal swabs were consistently negative. The patient experienced no improvement under widespectrum antibiotics administered initially, and greatly improved after receiving systemic corticosteroids. One can realize from our case that COVID-19 could not be ruled out upon repeated negative RT-PCR nasopharyngeal swabs, and in subjects with highly suspected COV-ID-19, it is justified to perform invasive procedures, but still using maximal protective measures.
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