Numerous extrapulmonary manifestations in patients with coronavirus disease 2019 (COVID-19) have been documented during the ongoing pandemic, thus making the clinical spectrum of this new disease very heterogeneous. 

Reports describe COVID-19–associated vasculitis and vasculopathy, while cutaneous leukocytoclastic vasculitis (cLcV) due to SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2) has rarely been reported, and if it has, with relatively mild courses. 

A report describes a case of a 93-year-old man who, after surviving classic COVID-19 infection, developed a fulminant cLcV leading to extensive skin necrosis and tissue damage, taking up his life. 

Ruling out other triggers of vasculitis, cLcV was discovered to be a secondary manifestation of COVID-19, even though SARS-CoV-2 polymerase chain reaction in the skin biopsy was not found in the tissue. Thus, the investigators hypothesize this by providing a pathophysiologic rationale (e.g., SARS-CoV-2–induced endotheliitis, complement activation and interleukin 6 dominant intra- and perivascular inflammation).

Thus cLcV may symbolize one of the several types of cutaneous manifestation of COVID-19 in patients of all ages. This case highlights how a COVID-19 infection with an initially mild presentation without severe pneumonia can progress to a critical illness resulting from non-pulmonary manifestations. It is recommended to monitor patients with risk factors for severe disease who present with mild COVID-19 manifestations and without lung involvement, even after virus clearance.

Source: Capoferri G, Daikeler T, Mühleisen B, et al. Cutaneous leukocytoclastic vasculitis secondary to COVID-19 infection leading to extensive skin necrosis.Clin Dermatol. 2022. https://doi.org/10.1016/j.clindermatol.2022.02.013.