Observation
A 65-year-old man with a history of hypertension, ischemic
cardiomyopathy, and chronic kidney failure on dialysis presented with
painful periungual erosions appeared seven days after coronarography.
Upon physical examination, we noticed periungual and pulpal erosions
with a fibrinous center and non-infiltrated erythematous border on both
index fingers and on the left second toe (Figure 1a, 1b). Peripheral
pulses were present. The ocular fundus was normal. Cutaneous biopsy was
not performed since it could slow scarring. Doppler ultrasound showed
signs of atherosclerosis without severe arterial obstruction. The
diagnosis of cholesterol embolization syndrome was made based on
clinical history and physical examination. The patient was treated as
such with a good evolution after 15 days and beginning of
re-epidermalization. One month later, a worsening of the same lesions
was noted with the onset of dry gangrene (Figure 2), followed 48 hours
later by chills and fever. He had no headache, no digestive or
respiratory signs and no hypoxemia. A PCR test on nasopharyngeal swab
was positive for SARS-CoV-2. Despite the initiation of anticoagulation
therapy, the patient died after two days of disseminated intravascular
coagulation.