The coronavirus disease 2019 (COVID-19) has been associated with several cardiovascular complications, like occlusive cardiovascular disease. Recent studies have suggested that these cardiovascular outcomes may also lead to cutaneous skin manifestations, including livedoid and necrotic eruptions in patients with severe COVID-19. This study aims to evaluate the risk of livedoid and purpuric skin eruptions associated with coagulopathy in patients with severe COVID-19.
This case series included 4 patients who had severe COVID-19 and acute respiratory distress syndrome that required intubation. The patients also had skin findings of acral fixed livedo racemosa and retiform purpura. Punch biopsies were performed for all the patients, and the primary outcome of the study was the presence of livedoid and purpuric eruptions.
The punch biopsy for each patient showcases pauci-inflammatory thrombogenic vasculopathy that involved capillaries, venules, and small arteries. The findings suggested that 3 of 4 patients had dermal arterial thrombosis. All patients had d-dimer levels higher than 3 μg/mL. The increase in d-dimer levels was attributed to the initiation of a standard prophylactic dose of anticoagulation therapy at admission.
The research concluded that livedoid and purpuric skin eruptions in patients with severe COVID-19 were the manifestations of cutaneous thrombosis and were a result of anticoagulation therapy at admission.