MS-4 NYIT COM East Meadow, New York, United States
Case Diagnosis: 53yoM diagnosed with lower extremity vasculitis following COVID-19 infection requiring bilateral below-knee amputation and acute inpatient rehabilitation.
Case Description: Patient was a previously well individual whose only prior medical diagnosis was hypertension. The patient was diagnosed with COVID-19 infection and admitted to the medical service. Following a short and uncomplicated hospital course, the patient was discharged home and then subsequently readmitted with bilateral leg wounds. The wounds did not heal with debridement and conservative management over the course of two months. The patient subsequently required bilateral below-knee amputations. Biopsy results revealed diffuse necrotizing vasculitis. The patient was then admitted to the acute inpatient rehab unit for two weeks. The patient is now able to walk with a SAC and K level 3 prosthetic devices.
Discussion: COVID-19 associated vasculitis and vasculopathy is a defining feature of systemic disease caused by the virus leading to acute or chronic health implications. The vasculitis occurs due to endothelial cell inflammation, dysfunction, and apoptosis. There has been shown affinity of SARS-Cov-2 to bind to endothelial cells resulting in inflammation, altered cell metabolism, and vascular dysfunction, especially in comorbid conditions including advanced age, diabetes, hypertension, and obesity. The COVID-19 pandemic is consistently presenting new challenges as the long-term complications of the disease begin to unfold. Many patients who were treated for COVID-19 infection and its complications can benefit from acute inpatient rehabilitation.
Conclusions: COVID-19 infection can lead to an exacerbation of preexisting vascular diseases or new-onset vasculitis. It is paramount for providers to follow up with COVID-19 patients to assess for possible long-term complications.