COVID-19-associated vasculitis is a term used to describe a genuine vasculitis associated with SARS- COV-2 infection when all other possible causes of vasculitis have been ruled-out. We report a case of a 66- year-old-male, reinfected by COVID-19 after 5 months, who presented with a 2-week history of multiple petechiae on bilateral anterior legs that gradually evolved into targetoid purpura with central blisters, spreading to the proximal medial thighs and the trunk, associated with pruritus and a warm sensation over the affected areas. The patient also presented with marked periorbital swelling, abdominal and joint pains, and decreased kidney function. Histopathology of the skin biopsy showed leukocytoclastic vasculitis while direct immunofluorescence study came out positive result for fibrinogen but negative for IgA, IgG, IgM and C3. Skin lesions resolved and kidney function improved prior to discharge after treatment with IV antibiotics (azithromycin 500 mg and ceftazidime 1 g) and IV steroids (hydrocortisone 50 mg). Recurrence of the vasculitic skin lesions occurred 2 weeks after being tagged as COVID-recovered but improved after 14 days of treatment with oral prednisone. We highlight the importance of recognizing cutaneous vasculitis as a possible marker of a severe COVID-19 disease which could be in the form of single-organ damage particularly acute kidney injury.
case report