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作为新型冠状病毒肺炎(COVID-19)感染的首发表现,出现上下肢缺血的突然发作。

Sudden development of the upper and lower limb ischemia as the first manifestation of COVID-19 infection.

作者信息

Aliasgarzadeh Shafagh, Arabzadeh AmirAhmad, Fathibitaraf Sepideh, Negaresh Mohammad

机构信息

Department of Internal Medicine, School of Medicine, Ardabil University of Medical Sciences, Ardabil, Iran.

Department of Surgery, School of Medicine, Ardabil University of Medical Sciences, Ardabil, Iran.

出版信息

Int J Surg Case Rep. 2022 Jul;96:107332. doi: 10.1016/j.ijscr.2022.107332. Epub 2022 Jun 21.

Abstract

INTRODUCTION AND IMPORTANCE

Atherosclerosis is the most common cause of peripheral vascular disease, and common predisposing causes are inflammation and diabetes. It is over two year that the COVID-19 pandemic has impacted the world and costed millions of lives.

CASE PRESENTATION

The patient was a case of COVID-19 infection presenting as acute arterial occlusion in the upper and lower limb.

CLINICAL DISCUSSION

Hyper coagulopathy is one of the COVID-19 outcomes that may develop PAD following the involvement of vascular endothelium in the cytokine storm phase. Endothelial damage following COVID-19, especially in those with underlying diseases such as diabetes mellitus or inflammatory diseases with vascular involvement, can cause acute vascular events.

CONCLUSION

Patients with inflammatory diseases and diabetes are prone to the uncommon symptoms of COVID-19 and more vulnerable to peripheral vascular occlusion, especially when the underlying disease remains uncontrolled, so anticoagulation with therapeutic doses is recommended for their treatment. Inflammation as a predisposing factor for PAD should be controlled using plasmapheresis or anti-inflammatory drugs depending on the patient's condition.

摘要

引言与重要性

动脉粥样硬化是外周血管疾病最常见的病因,常见的诱发因素是炎症和糖尿病。新冠疫情已影响全球两年有余,夺去了数百万人的生命。

病例介绍

该患者为新冠病毒感染病例,表现为上肢和下肢急性动脉闭塞。

临床讨论

高凝状态是新冠病毒感染的后果之一,在细胞因子风暴期血管内皮受累后可能发展为外周动脉疾病(PAD)。新冠病毒感染后的内皮损伤,尤其是在患有糖尿病等基础疾病或有血管受累的炎症性疾病的患者中,可导致急性血管事件。

结论

患有炎症性疾病和糖尿病的患者易出现新冠病毒感染的罕见症状,更容易发生外周血管闭塞,尤其是当基础疾病未得到控制时,因此建议使用治疗剂量的抗凝药物进行治疗。应根据患者情况,使用血浆置换或抗炎药物控制作为外周动脉疾病诱发因素的炎症。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/e8ec/9284048/20c85b43ebda/gr1.jpg

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