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.