Bogyeong Go, Doyeon Kim, Kyung Eun Jung, Young Lee, Young-Joon Seo, Dongkyun Hong

A Case of Retiform Purpura associated with Coronavirus Disease 2019 Infection

  • Infectious Diseases

Since the emergence of coronavirus disease 2019 (COVID-19), several reports have described various skin manifestations associated with COVID-19. Retiform purpura is a cutaneous manifestation that is likely associated with coagulopathy in patients with severe COVID-19. Here, we present the case of a 62-year-old man with hypertension and multiple myeloma who presented with retiform purpuric patches on both legs two days after a chemotherapy session with carfilzomib and dexamethasone. He had no other respiratory symptoms or fever; however, he was hospitalized for supportive care and underwent COVID-19 screening with reverse transcriptase polymerase chain reaction, which was positive. Histopathologic evaluation of the two punch biopsy samples obtained from the affected skin revealed perivascular lymphocytic lesions with fibrinoid degeneration, extravasated red blood cells, and fibrin deposition in the deep dermis. Based on these findings, the patient was diagnosed with COVID-19 and retiform purpura. He received intensive care after developing fever, cough, sputum production, and dyspnea. However, the patient developed multifocal cerebral infarctions and eventually died. Dermatologists should recognize retiform purpura, which may appear before other COVID-19 symptoms, as an alarm sign which can aid in the prompt implementation of appropriate treatment.

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