Case Presentation
A 26-year-old Asian female with a medical history of migraine was transferred to our center from a nearby hospital, where she presented with shortness of breath, tested positive for COVID-19, and was being managed for COVID-19 pneumonia. In the outside center, she was being managed with supplemental oxygen, Remdesivir, Dexamethasone, and Levofloxacin to cover community-acquired pneumonia (CAP). During the hospitalization, she developed hemoptysis. The tuberculosis workup was negative. She was started on Baricitinib and transferred to our center for specialized care and further workup, given worsening symptoms despite standard treatment.
At the presentation to our center, she complained of chest pain. A review of systems was notable for paresthesia on the dorsal aspect of the left foot. She was tachycardic and required a high-flow nasal cannula to maintain oxygen saturation >92%. Physical examination revealed diffuse bilateral crackles on lung auscultation and nodular non-blanching violaceous skin lesions on bilateral legs, which she attributed to shaving her legs. A patchy area of numbness was appreciated on the dorsal surface of the left leg. Initial laboratory results were significant for leukocytosis, elevated lactate dehydrogenase (LDH), procalcitonin, erythrocyte sedimentation rate (ESR), and C-reactive protein (CRP), as summarized in Table 1. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was detected on polymerase chain reaction (PCR). Electrocardiogram (EKG) revealed sinus tachycardia.