Retiform Purpura in the Setting of COVID-19: A Harbinger of Underlying Coagulopathy and Severe Disease Course

While the majority of COVID-19 cases are mild and can be managed in the outpatient setting, more severe cases have proven to be a clinical challenge. While some cases demonstrate a more slow and indolent decline, others seem to deteriorate rapidly with little forewarning. The current literature has connected Retiform Purpura as a cutaneous manifestation associated with severe COVID-19 infections, however timing of cutaneous presentation and severe clinical COVID-19 symptoms has not been well described. Here we report a case of a 58-year-old female who developed Retiform Purpura nearly a week prior to the development of any significant COVID-19 symptoms. This case demonstrates that Retiform Purpura is not only associated with severe COVID-19 disease, but can present prior to symptom onset and should be seen as a harbinger for impending clinical deterioration.

Cutaneous manifestations of COVID-19

There has been increasing number of reports on the cutaneousmanifestations of COVID-19 patients. The skin involvements in patients with COVID-19 demonstrate various clinical entities. In our article, we summarize these cutaneous manifestations based on the literature data and on our own experiencies. While in inducing maculopapulosus exanthem, urticaria, erythema multiformeand vesicular lesions etiological factors other than SARS-COV-2 virus may play a role , vascular manifestations, such as chilblain-like lesions and retiform purpura, could have a more direct association with the virus. Cutaneous manifestation may help in identifying asymptomatic patients and could provide prognostic information on the clinical course of COVID-19.