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.