Kyriakoudi Anna, Pontikis Konstantinos, Tsaraklis Athanasios, Soura Efthymia, Vourlakou Christine, Kossyvakis Athanasios, Potamianou Efstathia, Kaniaris Evangelos, Ioannidou Iliana, Mentis Andreas, Kloukina Ismini, Daganou Maria, Koutsoukou Antonia
ICU, 1st Department of Respiratory Medicine, National and Kapodistrian University of Athens Medical School, "Sotiria" Hospital, Athens, Greece.
Dermatology Department, "Sotiria" Hospital, Athens, Greece.
Case Rep Crit Care. 2021 Apr 3;2021:6644853. doi: 10.1155/2021/6644853. eCollection 2021.
We describe a critically ill, SARS-CoV-2 positive patient with respiratory failure and thrombotic/livedoid skin lesions, appearing during the course of the disease. The biopsy of the lesions revealed an occlusive, pauci-inflammatory vasculopathy of the cutaneous small vessels characterized by complement and fibrinogen deposition on vascular walls, pointing to a thrombotic vasculopathy. Transmission electron microscopy of the affected skin failed to reveal any viral inclusions. Clinical evaluation and laboratory findings ruled out systemic coagulopathies and disseminated intravascular coagulation, drug-induced skin reaction, and common viral rashes. Our hypothesis is that the, herein evidenced, microvascular occlusive injury might constitute a significant pathologic mechanism in COVID-19, being a common denominator between cutaneous and pulmonary manifestations.
我们描述了一名患有严重急性呼吸综合征冠状病毒2（SARS-CoV-2）感染的危重症患者，该患者在疾病过程中出现呼吸衰竭以及血栓形成/类生活史样皮肤病变。病变活检显示为皮肤小血管的闭塞性、少炎性血管病，其特征为血管壁上有补体和纤维蛋白原沉积，提示为血栓性血管病。对受累皮肤进行透射电子显微镜检查未发现任何病毒包涵体。临床评估和实验室检查结果排除了全身性凝血病和弥散性血管内凝血、药物性皮肤反应以及常见的病毒疹。我们的假设是，本文所证实的微血管闭塞性损伤可能是冠状病毒病（COVID-19）的一种重要病理机制，是皮肤和肺部表现的共同特征。
