The hypercoagulable state seen in Covid-19 patients has been well described. Our case of a patient with limb ischemia and elevated Antiphospholipid Syndrome (APS) antibodies raises the question of multiple mechanisms of hypercoagulability with Covid-19 infection. CASE PRESENTATION: 61 year old female with fibromyalgia and osteoarthritis presented with dyspnea and cough. On arrival, she was tachypneic (38 breaths/min) with low oxygen saturation (91%). Chest radiograph showed vascular congestion with bilateral interstitial infiltrates. She tested positive for SARS-CoV2 19 and was started on hydroxychloroquine, ceftriaxone, and azithromycin. She was intubated day 2 and was transferred to ICU, where she required vasopressor support for septic shock. She developed transient thrombocytopenia, which was attributed to sepsis, as Heparin-Induced Thrombocytopenia was ruled out. Her fingertips were cyanotic and toes gangrenous, concerning for limb ischemia. Given her instability, she was not a candidate for vascular intervention. Further workup revealed positive APS antibodies (Table 1) and therapeutic dose lovenox was started. Hospital course was further complicated by polymicrobial pneumonia with Computed Tomography Chest showing bilateral cavitations and traction bronchiectasis. Despite maximal therapy, she expired on day 33 of hospitalization.
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