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.
【초록키워드】 COVID-19, SARS-CoV-2, Respiratory failure, complement, Laboratory, Coagulopathy, Critically ill, clinical, Microscopy, Patient, Manifestations, fibrinogen, mechanism, Disseminated intravascular coagulation, Hypothesis, Injury, skin lesions, lesion, Vascular, thrombotic, positive, occlusive, rashes, Course, affected, pathologic, the disease, characterized, evidenced, small vessel, 【제목키워드】 COVID-19, Cutaneous, Vasculopathy, electron, Ill,