Disclosures: Taylor Stinnett, DO: No financial relationships or conflicts of interest

Case Diagnosis: 29-year-old male status post right transtibial amputation secondary to arterial thrombosis and critical limb ischemia

Case Description: The patient, with history only of asthma and mild COVID-19 infection in September 2020, initially presented to primary care December 2020 with right foot numbness. His symptoms progressed and he returned in February 2021 with pain and cyanosis of the toes. Imaging revealed thrombus involving the common femoral, deep femoral, superficial femoral, popliteal, anterior tibial, peroneal, and posterior tibial arteries. He underwent thrombolysis, but subsequently required extensive cutdown, thrombectomy, and 4 compartment fasciotomies. After initial return of motor function, he returned days later with worsening symptoms. Ultimately, he underwent right transtibial amputation and was admitted to acute inpatient rehabilitation.

Setting: Acute rehabilitation hospitalAssessment/

Results: A previously healthy male developed an extensive arterial thrombus after a COVID-19 infection. He had no prior risk factors or family history of hypercoagulability, and hypercoagulable work-up was unremarkable. Etiology of arterial thrombosis was considered likely due to prior COVID-19 infection.

Discussion: This case presents a unique musculoskeletal consequence following COVID-19 infection. Initially presenting with sensory deficits in the right leg and with absence of typical warning signs or risk factors, ischemic causes were not considered. Timely ischemic workup and interventions were delayed in this young, active male, and he required a transtibial amputation. However, he has excellent potential to return to his previous lifestyle following aggressive rehabilitation with acute inpatient rehabilitation for pre-prosthetic training followed by targeted prosthetic training as an outpatient.

Conclusion: The association between hypercoagulability and COVID-19 infection has been well established. Attention to vague symptoms of limb ischemia could prompt earlier evaluation and subsequent expedited treatment to prevent limb loss in seemingly healthy, low risk individuals with history of COVID-19 infection. Our case serves as a novel example to consider this diagnosis in these patients before they reach critical limb ischemia.

Level of Evidence: Level V

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/transtibial-amputation-following-covid-19-infection-in-a-29-year-old-man-a-case-report/