Peripheral symmetric gangrena in patients with SARS-CoV-2 infection

Introduction: COVID-19 infection, although mainly with respiratory involvement, has revealed various clinical manifestations at the extrapulmonary level. Vascular involvement is common in the intensive care unit, although its pathophysiology is not clear today. Case report: we present the case of a 73-year-old man, with a history of cryoglobulinemia, admitted to the intensive care unit due to bilateral COVID-19 pneumonia. It required the initiation of vasoactive drugs at low doses, and distal ischemia of the four extremities was progressively evident, establishing the differential diagnosis between thrombotic microangiopathy or reactivation of cryoglobulinemia. Discussion: the appearance of thrombotic processes and the high risk of hemorrhage in patients with SARS-CoV-2 infection has been one of the greatest challenges regarding the treatment of this pathology. Small-vessel vascular complications, mostly due to distal microangiopathic processes, have brought to the fore the risk / benefit of anticoagulation, the appropriate dose, and its duration.