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      Ecchymosis in critical coronavirus disease 2019 (COVID-19) patient in Tangerang, Indonesia: a case report

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          Abstract

          We have read with great interest the articles regarding cutaneous manifestations in Coronavirus Disease 2019 (COVID-19) infection. Studies showed 20.4% of COVID-19 patients developed cutaneous manifestations. COVID-19 causes vascular endothelial injury, vasculitis and prothrombotic state which might be the underlying cause of hemorrhagic cutaneous manifestations, disseminated intravascular coagulation (DIC), and multiple organ failures. To date, hemorrhagic cutaneous manifestations reported are chilblain-like lesion, purpura to ecchymosis, livedo reticularis, and dry gangrene. We present a case of ecchymosis in COVID-19-positive ICU hospitalized patient.

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          Abnormal coagulation parameters are associated with poor prognosis in patients with novel coronavirus pneumonia

          Ning Tang, Dengju Li, Xiong Wang … (2020)
          Abstract Background In the recent outbreak of novel coronavirus infection in Wuhan, China, significantly abnormal coagulation parameters in severe novel coronavirus pneumonia (NCP) cases were a concern. Objectives To describe the coagulation feature of patients with NCP. Methods Conventional coagulation results and outcomes of 183 consecutive patients with confirmed NCP in Tongji hospital were retrospectively analyzed. Results The overall mortality was 11.5%, the non‐survivors revealed significantly higher D‐dimer and fibrin degradation product (FDP) levels, longer prothrombin time and activated partial thromboplastin time compared to survivors on admission (P < .05); 71.4% of non‐survivors and 0.6% survivors met the criteria of disseminated intravascular coagulation during their hospital stay. Conclusions The present study shows that abnormal coagulation results, especially markedly elevated D‐dimer and FDP are common in deaths with NCP.
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            Complement associated microvascular injury and thrombosis in the pathogenesis of severe COVID-19 infection: A report of five cases

            Cynthia M Magro, J. Mulvey, David Berlin … (2020)
            Acute respiratory failure and a systemic coagulopathy are critical aspects of the morbidity and mortality characterizing infection with severe acute respiratory distress syndrome-associated coronavirus-2 (SARS-CoV-2), the etiologic agent of Coronavirus disease 2019 (COVID-19). We examined skin and lung tissues from 5 patients with severe COVID-19 characterized by respiratory failure (n=5) and purpuric skin rash (n=3). The pattern of COVID-19 pneumonitis was predominantly a pauci-inflammatory septal capillary injury with significant septal capillary mural and luminal fibrin deposition and permeation of the inter-alveolar septa by neutrophils. No viral cytopathic changes were observed and the diffuse alveolar damage (DAD) with hyaline membranes, inflammation, and type II pneumocyte hyperplasia, hallmarks of classic ARDS, were not prominent. These pulmonary findings were accompanied by significant deposits of terminal complement components C5b-9 (membrane attack complex), C4d, and mannose binding lectin (MBL)-associated serine protease (MASP)2, in the microvasculature, consistent with sustained, systemic activation of the alternative and lectin-based complement pathways. The purpuric skin lesions similarly showed a pauci-inflammatory thrombogenic vasculopathy, with deposition of C5b-9 and C4d in both grossly involved and normally-appearing skin. In addition, there was co-localization of COVID-19 spike glycoproteins with C4d and C5b-9 in the inter-alveolar septa and the cutaneous microvasculature of two cases examined. In conclusion, at least a subset of sustained, severe COVID-19 may define a type of catastrophic microvascular injury syndrome mediated by activation of complement pathways and an associated procoagulant state. It provides a foundation for further exploration of the pathophysiologic importance of complement in COVID-19, and could suggest targets for specific intervention.
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              Coagulopathy and Antiphospholipid Antibodies in Patients with Covid-19

              Yan Yan Zhang, Meng Xiao, Shulan Zhang … (2020)
              Coagulopathy in Critical Illness with Covid-19 The authors describe a 69-year-old man with Covid-19 diagnosed in January 2020 in Wuhan, China, along with two other critically ill patients with Covid-19 who were also seen in the same intensive care unit. Coagulopathy and antiphospholipid antibodies were seen in all three patients.
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                Author and article information

                Contributors
                Allen Widysanto:
                ORCID: http://orcid.org/0000-0003-3598-2545
                allenwidy@yahoo.co.id
                Journal
                Journal ID (nlm-ta): J Thromb Thrombolysis
                Journal ID (iso-abbrev): J Thromb Thrombolysis
                Title: Journal of Thrombosis and Thrombolysis
                Publisher: Springer US (New York )
                ISSN (Print): 0929-5305
                ISSN (Electronic): 1573-742X
                Publication date (Electronic): 17 November 2020
                Pages: 1-5
                Affiliations
                [1 ]Siloam Hospitals Kelapa Dua, Tangerang, Indonesia
                [2 ]GRID grid.443962.e, ISNI 0000 0001 0232 6459, Faculty of Medicine, , Pelita Harapan University, ; Tangerang, Indonesia
                Author information
                http://orcid.org/0000-0003-3598-2545
                http://orcid.org/0000-0001-9853-0752
                http://orcid.org/0000-0001-5261-6999
                Article
                Publisher ID: 2338
                DOI: 10.1007/s11239-020-02338-7
                PMC ID: 7671180
                PubMed ID: 33205222
                SO-VID: 43128ac8-de03-4e64-9c81-77667a3b1097
                Copyright © © Springer Science+Business Media, LLC, part of Springer Nature 2020
                License:

                This article is made available via the PMC Open Access Subset for unrestricted research re-use and secondary analysis in any form or by any means with acknowledgement of the original source. These permissions are granted for the duration of the World Health Organization (WHO) declaration of COVID-19 as a global pandemic.

                History
                Date accepted : 9 November 2020
                Categories
                Subject: Article

                ScienceOpen disciplines: Hematology
                Keywords: covid-19,cutaneous manifestation,dic,ecchymosis,vasculopathy
                Data availability:
                ScienceOpen disciplines: Hematology
                Keywords: covid-19, cutaneous manifestation, dic, ecchymosis, vasculopathy

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