J Korean Foot Ankle Soc.  2022 Mar;26(1):48-53. 10.14193/jkfas.2022.26.1.48.

Effect of Severe Limb Purpura Following the Administration of COVID-19 Vaccination on a Diabetic Foot Requiring Amputation: A Case Report

• Kim BH
• Suh JS
• Chang SH
• Choi JY

• KMID: 2527012
• DOI: http://doi.org/10.14193/jkfas.2022.26.1.48

Abstract

The current SARS-CoV‑2 coronavirus disease 2019 (COVID-19) pandemic has been a particular challenge for diabetes patients. Since these patients are at a higher risk of COVID-19, they have been prioritized for vaccination. In this report, we describe the case of a patient scheduled for diabetic foot amputation who received the first dose of ChAdOx1 nCov-19 vaccine and subsequently developed severe purpura in his genitalia and both of his hands and feet, accompanied by acute renal failure. The operation had to be postponed as severe limb purpura appeared just before the operation. With adequate management for acute renal failure and topical steroid application for the severe purpura lesions, a successful outcome could be obtained after the delayed first ray amputation. We recommend that COVID-19 vaccination should be carefully administered in patients with a diabetic foot requiring amputation.

Keyword

COVID-19; Vaccine; Purpura; Diabetic foot; Amputation

Figure

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  Figure. 1 Anteroposterior and lateral toe radiographs show the osteolytic lesion of the distal phalanx (arrow), which suggests chronic osteomyelitis (A). The patient presents with limb pain and severe purpura on the genitalia and both hands (B) and feet (C).

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  Figure. 2 Histopathological findings. A histopathological evaluation confirms the dermal perivascular inflammation and edema with superficial epidermal pustule formation (A). Red blood cell extravasation and variable fibrinoid necrosis (asterisk) of vessel walls are shown (B). The blood vessels are surrounded by a dense inflammatory infiltrate composed of eosinophils (arrow) and lymphocytes (C). (A) H&E stain, ×100; (B) H&E stain, ×400; (C) H&E stain, ×400.

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  Figure. 3 Compared to those at three days after hospital admission (A), the purpura slowly improved while the original left great-toe lesion remains untreated at 2 weeks (B).

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  Figure. 4 Intraoperative findings. Intraoperatively, the infection spread proximally along the flexor hallucis longus tendon (A), so the first ray amputation is performed (B).

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  Figure. 5 At 3 weeks of hospital admission, hand purpura completely improves.

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  Figure. 6 Progress of amputation wound. During the 24 postoperative weeks, the wound slowly improved with daily dressing, without further deterioration.

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