New Delhi: A study by doctors from Dr Ram Manohar Lohia (RML) Hospital in Delhi has said signs of gangrene on the skin could be a significant marker of Covid-19.
Their paper referred to a case of a 65-year-old Covid patient with no comorbidities, who developed signs of gangrene before the typical respiratory symptoms associated with Covid.
Gangrene is the condition where tissues die due to a lack of blood supply. According to Mayo Clinic, the condition is marked by discolouration of skin, pain, swelling, and foul smelling discharge emanating from a sore.
In their paper published on 12 May in the Journal of Cosmetic Dermatology, the doctors noted that though there are several reports of Covid affecting the skin, such as rashes, most are “insignificant” since they “do not indicate specificity” to the disease. The researchers included Dr Shubhra Shubhra, Dr Amlendu Yadav, Dr Kabir Sardana, and Dr Ajay Kumar Goila from RML Hospital.
In the case that was studied, however, the development of gangrene due to clotting of blood in one limb served as an indicator of the disease’s progression, “with sepsis and skin manifestations that correlate with severity”. Covid-19 is known to cause blood clots rare, severe cases.
Sepsis occurs when an infection in the body triggers a chain reaction that could result in organ and tissue damage, and even lead to multiple organ failure.
“While we report an atypical and hitherto unreported unilateral (one-sided) thrombosis with gangrene, we feel that such clinical manifestations that can predict severity and are suggestive of aggressive clinical intervention will have more clinical utility in practice than other skin findings which may be inconsequential for the clinical course of the disease,” the doctors said in the report.
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Case study
The 65-year-old patient had no prior comorbidities or a history of prothrombotic disease (a condition making one prone to developing blood clots). The patient, though, “presented with complaints of weakness and pain in right lower limb for 10 days, followed by cough and fever (102°Farenheit) for 5 days”, meaning they developed respiratory symptoms after reporting pain in the lower right limb, where the clotting occurred.
Doctors noticed a “dark diffuse discoloration of the right lower limb”, and noticed that the skin showed wet gangrenous changes of the right lower limb, according to the paper. The patient also had edema (swelling), and there was no pulse in the right lower limb’s arteries.
“Antibiotics and steroids were started for the treatment of sepsis and COVID along with aggressive management of thrombosis but the patient died of pulmonary embolism 5 days after the admission,” the paper said.
Significance
The doctors noted that though thrombosis associated with Covid-19 has had skin manifestations before, this is the first time a large blood clot affecting almost the entire limb has been reported.
Other Covid-19 skin manifestations, such as rashes, are “secondary” to the infection and not because of “direct viral skin toxicity,” noted the paper.
In this case, the visible manifestation of thrombosis, which occurred before the respiratory symptoms showed, can offer clues into the severity of Covid-19 illness and as such can “portend a fatal prognosis”, the doctors said.
(Edited by Manasa Mohan)
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