Fulminant Leukocytoclastic Vasculitis with Gangrene Necessitating Bilateral Below-knee Amputation in a Patient with Mild COVID-19 Infection: An Atypical Presentation

Covid-19, caused by SARS-CoV-2, is known for its diverse systemic effects, though rheumatological and cutaneous manifestations are relatively uncommon. We report a striking case of a middle-aged Caucasian woman who developed a diffuse, bilateral rash that progressed to gangrenous lesions. Despite testing positive for SARS-CoV-2, she exhibited no respiratory symptoms. After excluding thromboembolic events and other vasculitides, a skin biopsy confirmed leukocytoclastic vasculitis, leading to a diagnosis of COVID-19-associated leukocytoclastic vasculitis. The extensive gangrenous progression ultimately required bilateral below-knee amputation, despite medical management. While mild vasculitic presentations have been observed in COVID-19 patients, progression to such severe gangrenous lesions is extremely rare. This case underscores the potential for devastating cutaneous complications in SARS-CoV-2 infections, highlighting the need for heightened awareness and further research into the pathogenic mechanisms of COVID-19-related vasculopathies.