LAUSR

Dear Editor, Cutaneous manifestations of COVID-19 disease have been widely characterized. Livedo or necrosis pattern, accounting for 6% of cutaneous manifestations, is associated with more severe disease (Galván Casas et al., 2020). It has been related to vascular occlusion secondary to coagulopathy and vascular damage (Zhang et al., 2020). Ischemic lesions due to vasculitis with negative serology has been reported associated to COVID-19 infection in two scenarios: drug-induced vasculitis (Vanegas Ramirez et al., 2020) and secondary to COVID-19 infection itself (Mayor-Ibarguren et al., 2020). Although practice recommendations on the management of patients requiring microsurgery in times of COVID-19 have been reported (Hsieh et al., 2020; Ramella et al., 2020), little is known about technical considerations of microsurgical reconstruction in a patient with tissue necrosis secondary to vasculitis COVID-19 disease. We describe a patient with COVID-19 severe disease and vasculitic acro-ischemic lesions in her right hand that required microvascular free tissue transfer. The patient was diagnosed of COVID19 pneumonia on March 2020, on the basis of SARS-CoV-2 detected at RT-PCR testing. One week after the diagnosis, infiltrated erythematous plaque appeared in left buttock, unrelated to contact allergies or decubitus, which spontaneously solved. On April 2020, under low doses of norepinephrine, the patient manifested ischemic signs in right thumb distal phalanx and livedoid lesions in homolateral dorsum of the hand associated to pain (Figure 1(a),(b)). Autoimmunity serological analysis showed negative values for antinuclear antibodies (ANAs), anti-neutrophil cytoplasmic antibodies (ANCAs) and anticardiolipin antibodies. Component C3 was detected in serum. Biopsy of the hand lesion suggested the diagnosis of COVID-19 vasculitis.