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Catastrophic Coronavirus Disease COVID Infection Leading to Gangrene of Foot in Peripartum Women
INTRODUCTION: Pregnancy is a physiologically hypercoagulable state and a coronavirus disease 2019 (COVID-19) infection adds to this burden by accentuating the coagulopathy. We report two cases of severe peri-partum COVID infection leading to extremity gangrene secondary to a pro-thrombotic coagulopa...
Autores principales: | , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Indian Orthopaedic Research Group
2021
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8930342/ https://www.ncbi.nlm.nih.gov/pubmed/35415156 http://dx.doi.org/10.13107/jocr.2021.v11.i09.2422 |
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author | Vincent, Chandan Noel Elango, S Rai, Dinakar Kumar, Sujith Sivakumar, Ajay |
author_facet | Vincent, Chandan Noel Elango, S Rai, Dinakar Kumar, Sujith Sivakumar, Ajay |
author_sort | Vincent, Chandan Noel |
collection | PubMed |
description | INTRODUCTION: Pregnancy is a physiologically hypercoagulable state and a coronavirus disease 2019 (COVID-19) infection adds to this burden by accentuating the coagulopathy. We report two cases of severe peri-partum COVID infection leading to extremity gangrene secondary to a pro-thrombotic coagulopathy. CASE ONE: A 37-year-old lady, day-2 postpartum, was brought with severe COVID infection & and respiratory failure. She developed progressive gangrene of the foot. A computed tomography (CT) angiogram confirmed the presence of thrombosis of the left external iliac & and common femoral artery. She was managed with catheter- directed thrombolysis and fasciotomy. The dry gangrene of the foot was managed with a Boyd’s amputation. At 1-year follow-up, she is ambulant with a healthy stump. CASE TWO: A 34-year-old lady, 36 weeks of gestation, presented with fulminant COVID infection with respiratory failure and pulmonary embolus. The lady developed gangrene of the B/L toes. A CT angiogram revealed thrombosis below the popliteal trifurcation in both limbs along with segmental pulmonary thrombo-embolism involving the right lung and multiple splenic infarcts. She succumbed to the overwhelming infection and sepsis. DISCUSSION: The pathogenesis of coagulopathy in pregnant COVID patients is attributed to the hypercoagulable effect, which leads to thrombo-embolisms and limb ischemia following a cytokine storm syndrome in severe infections. To date, this is the first experience detailing distal limb gangrene in fulminant COVID infection in peri-partum women. Although, cases have been reported on distal limb gangrene in severe COVID infection among non-pregnant individuals. CONCLUSION: A multidisciplinary team must manage COVID infections in the third trimester. A prompt recognition of any forms of lethal coagulopathy and vigilant treatment will prevent loss of life. |
format | Online Article Text |
id | pubmed-8930342 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2021 |
publisher | Indian Orthopaedic Research Group |
record_format | MEDLINE/PubMed |
spelling | pubmed-89303422022-04-11 Catastrophic Coronavirus Disease COVID Infection Leading to Gangrene of Foot in Peripartum Women Vincent, Chandan Noel Elango, S Rai, Dinakar Kumar, Sujith Sivakumar, Ajay J Orthop Case Rep Original Article INTRODUCTION: Pregnancy is a physiologically hypercoagulable state and a coronavirus disease 2019 (COVID-19) infection adds to this burden by accentuating the coagulopathy. We report two cases of severe peri-partum COVID infection leading to extremity gangrene secondary to a pro-thrombotic coagulopathy. CASE ONE: A 37-year-old lady, day-2 postpartum, was brought with severe COVID infection & and respiratory failure. She developed progressive gangrene of the foot. A computed tomography (CT) angiogram confirmed the presence of thrombosis of the left external iliac & and common femoral artery. She was managed with catheter- directed thrombolysis and fasciotomy. The dry gangrene of the foot was managed with a Boyd’s amputation. At 1-year follow-up, she is ambulant with a healthy stump. CASE TWO: A 34-year-old lady, 36 weeks of gestation, presented with fulminant COVID infection with respiratory failure and pulmonary embolus. The lady developed gangrene of the B/L toes. A CT angiogram revealed thrombosis below the popliteal trifurcation in both limbs along with segmental pulmonary thrombo-embolism involving the right lung and multiple splenic infarcts. She succumbed to the overwhelming infection and sepsis. DISCUSSION: The pathogenesis of coagulopathy in pregnant COVID patients is attributed to the hypercoagulable effect, which leads to thrombo-embolisms and limb ischemia following a cytokine storm syndrome in severe infections. To date, this is the first experience detailing distal limb gangrene in fulminant COVID infection in peri-partum women. Although, cases have been reported on distal limb gangrene in severe COVID infection among non-pregnant individuals. CONCLUSION: A multidisciplinary team must manage COVID infections in the third trimester. A prompt recognition of any forms of lethal coagulopathy and vigilant treatment will prevent loss of life. Indian Orthopaedic Research Group 2021-09 2021-09 /pmc/articles/PMC8930342/ /pubmed/35415156 http://dx.doi.org/10.13107/jocr.2021.v11.i09.2422 Text en Copyright: © Indian Orthopaedic Research Group https://creativecommons.org/licenses/by-nc-sa/3.0/This is an open-access article distributed under the terms of the Creative Commons Attribution-Noncommercial-Share Alike 3.0 Unported, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. |
spellingShingle | Original Article Vincent, Chandan Noel Elango, S Rai, Dinakar Kumar, Sujith Sivakumar, Ajay Catastrophic Coronavirus Disease COVID Infection Leading to Gangrene of Foot in Peripartum Women |
title | Catastrophic Coronavirus Disease COVID Infection Leading to Gangrene of Foot in Peripartum Women |
title_full | Catastrophic Coronavirus Disease COVID Infection Leading to Gangrene of Foot in Peripartum Women |
title_fullStr | Catastrophic Coronavirus Disease COVID Infection Leading to Gangrene of Foot in Peripartum Women |
title_full_unstemmed | Catastrophic Coronavirus Disease COVID Infection Leading to Gangrene of Foot in Peripartum Women |
title_short | Catastrophic Coronavirus Disease COVID Infection Leading to Gangrene of Foot in Peripartum Women |
title_sort | catastrophic coronavirus disease covid infection leading to gangrene of foot in peripartum women |
topic | Original Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8930342/ https://www.ncbi.nlm.nih.gov/pubmed/35415156 http://dx.doi.org/10.13107/jocr.2021.v11.i09.2422 |
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