COVID-19-induced digital ischemia in antiphospholipid syndrome.

A 37-year-old man, a long-standing history of primary antiphospholipid syndrome (APS), was referred to our department due to a five-day history of skin discoloration in the left foot fingers that were painful. He was diagnosed as having primary APS based on antiphospholipid antibody positivity in repeated measurements at 12-week intervals and deep vein thrombosis of the lower extremity. A detailed clinical history revealed dry cough and myalgia. He also denied smoking or using any medications other than vitamin K antagonist. Physical examination revealed acral ischemic lesions the left foot (Figure 1). Pulses of lower limb were palpable. Doppler sonography of the lower limbs and electrocardiogram showed no abnormalities. Nasopharyngeal swab was positive for novel coronavirus 2019 disease (COVID-19) and chest X-ray showed peripheral consolidations without respiratory distress. The blood test revealed elevated acute phase reactants, D-dimer level, and fibrinogen degradation products. The international normalized ratio (INR) was 2. No venous thromboembolism was found in association, embolic causes were ruled out, and positivity for antiphospholipid antibodies (anticardiolipin immunoglobulin [Ig] M 99 U/mL and IgG >120 U/mL) was confirmed. The patient was followed with the diagnosis of digital ischemia in the context of COVID-19 and was initiated hydroxychloroquine (HCQ) and his prior treatment was switched for low-molecularweight heparin (LMWH). The lesions and