DOI: http://dx.doi.org/10.18203/2349-2902.isj20214026

COVID vaccine related lower limb gangrene: the first case report

Nishant Lal, Saajid Ali Khan, Aiswarya R. Pillai, Shafy Ali Khan

Abstract


Though there have been multiple cases of arterial thrombosis and gangrene of limbs reported following COVID-19 infections, there has not been any case reported following COVID-19 vaccinations. Here we reported a case of acute lower limb ischemia following COVID-19 vaccination in a 32 year male with no co-morbidities. The clinical symptoms and signs related to lower limb ischemia started 2 weeks after COVID-19 vaccination. Despite anticoagulation, thrombo embolectomy and intraluminal catheter guided thrombolysis, patient’s left forefoot became gangrenous and had to be amputated.


Keywords


COVID-19 vaccine, Lower limb ischemia, Gangrene, COVID related vascular complications

Full Text:

PDF

References


WHO. Fact sheet: COVID-19 China, 2020. Available at: who.int/csr/don/05-january-2020-pneumonia-of-unkown-cause-china/en/. Accessed on 6 July 2021.

Huang C, Wang Y, Li X, Ren L, Zhao J, Hu Y, et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet. 2020;395(10223):497-506.

Klok FA, Kruip MJ, Meer NJV, Arbous MS, Gommers DA, Kant KM, et al. Confirmation of the high cumulative incidence of thrombotic complications in critically ill ICU patients with COVID-19: an updated analysis. Thromb Res. 2020;191:148-50.

Andrews MA, Areekal B, Rajesh KR, Krishnan J, Suryakala R, Krishnan B, et al. First confirmed case of COVID-19 infection in India: a case report. Indian J Med Res. 2020;151(5):490-2.

Lee SG, Fralick M, Sholzberg M. Coagulopathy associated with COVID-19. CMAJ. 2020;192(21):583.

Oxley TJ, Mocco J, Majidi S, Kellner CP, Shoirah H, Singh IP, et al. Large-vessel stroke as a presenting feature of COVID-19 in the young. N Engl J Med. 2020;382(20):60.

Menter T, Haslbauer JD, Nienhold R, Savic S, Hopfer H, Deigendesch N, et al. Postmortem examination of COVID-19 patients reveals diffuse alveolar damage with severe capillary congestion and variegated findings in lungs and other organs suggesting vascular dysfunction. Histopathology. 2020;77(2):198-209.

Magro C, Mulvey JJ, Berlin D, Nuovo G, Salvatore S, Harp J, et al. Complement associated microvascular injury and thrombosis in the pathogenesis of severe COVID-19 infection: a report of five cases. Transl Res. 2020;220:1-13.

Bikdeli B, Madhavan MV, Jimenez D, Chuich T, Dreyfus I, Driggin E, et al. Global COVID-19 thrombosis collaborative group, endorsed by the ISTH, NATF, ESVM, and the IUA, supported by the esc working group on pulmonary circulation and right ventricular function. covid-19 and thrombotic or thromboembolic disease: implications for prevention, antithrombotic therapy, and follow-up: JACC state-of-the-art review. J Am Coll Cardiol. 2020;75(23):2950-73.

Beyrouti R, Adams ME, Benjamin L, Cohen H, Farmer SF, Goh YY, et al. Characteristics of ischaemic stroke associated with COVID-19. J Neurol Neurosurg Psychiatry. 2020;91(8):889-91.

Zhang Y, Xiao M, Zhang S, Xia P, Cao W, Jiang W, et al. Coagulopathy and antiphospholipid antibodies in patients with COVID-19. N Engl J Med. 2020;382(17):38.

Ranucci M, Ballotta A, DiDedda U, Bayshnikova E, Poli MD, Resta M, et al. The procoagulant pattern of patients with COVID-19 acute respiratory distress syndrome. J Thromb Haemost. 2020;18(7):1747-51.

Bowles L, Platton S, Yartey N, Dave M, Lee K, Hart DP, et al. Lupus anticoagulant and abnormal coagulation tests in patients with COVID-19. N Engl J Med. 2020;383(3):288-90.

Anwar S, Acharya S, Shabih S, Khabut A. Acute limb ischemia in COVID-19 disease: a mysterious coagulopathy. Cureus. 2020;12(7):9167.

Zhang Y, Cao W, Xiao M, Li YJ, Yang Y, Zhao J, et al. Clinical and coagulation characteristics of 7 patients with critical COVID-2019 pneumonia and acro-ischemia. Zhonghua Xue Ye Xue Za Zhi. 2020;41(0):006.

Bellosta R, Luzzani L, Natalini G, Pegorer MA, Attisani L, Cossu LG, et al. Acute limb ischemia in patients with COVID-19 pneumonia. J Vasc Surg. 2020;72(6):1864-72.

Galanis N, Stavraka C, Agathangelidis F, Petsatodis E, Giankoulof C, Givissis P. Coagulopathy in COVID-19 infection: a case of acute upper limb ischemia. J Surg Case Rep. 2020;2020(6):204.