key: cord-0929872-y0js8oxq
authors: Perea Polak, Alexandra; Romero Madrid, Beatriz; García Ocaña, Paula Patricia; Lomeña Alvarez, Guillermo; Martínez Pilar, Leandro; Gómez‐Moyano, Elisabeth
title: Complement‐mediated thrombogenic vasculopathy in COVID‐19
date: 2020-12-01
journal: Int J Dermatol
DOI: 10.1111/ijd.15267
sha: de8e2e0e1fd8e11fec0a1dcf98d9ede8bc3ac7af
doc_id: 929872
cord_uid: y0js8oxq

nan

with losartan and depression, with a recent history of cognitive impairment.

Physical examination showed punctiform purpura on the arms and lower legs (Fig. 1a) . Peripheral pulses in the right leg were absent. Oxygen saturation (SaO2) was 98% in air, and the blood pressure was 70/56 mmHg.

Laboratory values included hemoglobin 8.1 g/dl (12-16.5);14,600 white blood cells/ll (4,000-11,500); creatinine 3 mg/dl (0.43-0.96); D-dimer level 5,977 ng/ml (220-500); LDH 281 U per liter (120-246); elevated C reactive protein 279 mg/l; and troponin I 128 ng/l (3-58). The platelet count as well as prothrombin and activated partial thromboplastin times were all normal. Doppler ultrasound showed complete occlusion of the right common femoral artery, requiring supracondylar amputation.

A skin biopsy of purpuric lesion revealed small intraluminal fibrin-hematic thrombi (Fig. 1b) . Direct immunofluorescence showed C3 deposition in the wall of the superficial dermal capillary plexus (Fig. 1c) . Autoantibody studies showed a positive direct Coombs test, and direct antibody testing was positive for C3. Anticardiolipin, anti-b2-glycoprotein antibodies, and lupus anticoagulant were all negative.

Chest and abdominal computed tomography studies showed bilateral pulmonary thromboembolism (Fig. 2a) , as well as bilateral peripheral ground-glass opacities and focal consolidation 

Prevention Treatment of VTE Associated with COVID-19 Infection Consensus Statement Group. Prevention and Treatment of Venous Thromboembolism Associated with Coronavirus Disease 2019 Infection: A Consensus Statement before Guidelines

Figure 2 (a) Computed tomography angiography showed massive bilateral pulmonary thromboembolism. (b) Computed tomography showed bilateral and peripheral ground-glass opacities with consolidations. (c) Computed tomography angiography showed a hypodense lesion with triangular morphology in the spleen, compatible with splenic infarction

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Severe COVID-19 infection and thrombotic microangiopathy: success doesn't come easily

The first case of COVID-19 treated with the complement

Will complement inhibition be the new target in treating COVID-19 related systemic thrombosis?

COVID-19, microangiopathy, hemostatic activation, and complement

Pulmonary embolism or pulmonary thrombosis in COVID-19? Is the recommendation to use high-dose heparin for thromboprophylaxis justified?

To all the health care professionals and patients who are battling on the front line of the COVID-19 epidemic.