Amoxicillin/clavulanic-acid/dexamethasoneVascular graft infection and off-label use: case report A 51-year-old man developed vascular graft infection during off-label treatment with dexamethasone for COVID-19. He also received off-label treatment with amoxicillin and clavulanic acid for COVID-19.The man presented to an emergency department on 15 December 2020 with chest pain and hypertensive crisis corrected by unspecified ACE inhibitors. Upon further evaluation, he was found to be positive for COVID-19. He started receiving off-label treatment with amoxicillin, clavulanic-acid and dexamethasone [routes and dosages not stated]. Additionally, he received unspecified low-molecular-weight-heparins [low-molecular-weight heparin] in prophylactic dosage. However, he reported worsening pain and weakness in the left lower limb on the following days. Further analyses revealed bilateral viral pneumonia with partial resorption along with pulmonary embolism in the right middle lobes of lateral and medial segments. As a result, lowmolecular-weight-heparins dose was increased to therapeutic dosage. Additionally, thrombosis of infrarenal aorta, bilateral common iliac arteries and left external iliac artery was observed. Further, his leg ischemia deteriorated. He then underwent an extraanatomic axillo-bifemoral bypass on 28 December. However, wound healing appeared to be compromised on day 3 of operation. An ultrasound scan on the postoperative day 5 confirmed vascular graft infection [duration of treatment to reaction onset and outcome not stated]. His vascular graft infection was attributed to administration of corticosteroid (dexamethasone), ongoing pneumonia, obesity and prolonged preoperative hospitalization. He recovered from COVID-19. On 8 January, the infected axillobifemoral shunt was removed. Additionally, he underwent an open endarterectomy of infrarenal aorta, right common iliac and left external iliac arteries and remote endarterectomy in the left common iliac artery. The blood flow was restored to his legs successfully. He was discharged from the hospital on 25 January without any complications.