Acute Limb Ischemia Rutherford Classification III and COVID-19: A Case Report

Abstract

Background: COVID-19 is caused by SARS-CoV-2 infections, which are responsible for the recent pandemic. COVID-19 infection increases thromboembolic events, including Acute Limb Ischemia (ALI) by causing elevated cytokine levels, systemic inflammation, hypercoagulation state, and hyperinflammation responses. This complication might cause loss of limbs. Case description: We report a case of a 61-year-old male with COVID-19 who developed an ALI. He presented to the emergency department with acute left leg pain since a day before admission and shortness of breath three days before admission. His left foot was bluish-discolored, cold to the touch, and mottled in appearance. Chest x-ray showed bilateral inhomogeneous consolidation. Left lower limb X-ray revealed a gangrenous appearance. CT-Angiography suggested severe distal stenosis of the left femoral artery with complete occlusion of its distal aspect. COVID-19 was diagnosed based on RT-PCR testing. He received antibiotics and anticoagulation. Unfortunately, he underwent an amputation procedure. Conclusion: A high index of suspicion should be maintained for ALI in COVID-19 patients, which is a vascular emergency. Some patients can achieve revascularization with observation or medical and/or surgical intervention, but other patients succumb to either amputation or death.