Case Report: COVID-19-associated gangrene of fingers in a patient with autoimmune haemolytic anaemia.

Introduction: This case report describes a 50-year-old man with a 12-year history of long-standing warm-antibody autoimmune haemolytic anaemia (AIHA) who developed peripheral digital gangrene following COVID-19 infection. Although COVID-19-associated AIHA and COVID-19-associated digital ischaemia have each been reported separately, this case is notable for their coexistence with both venous and arterial thrombosis, resulting in tissue loss. Main symptoms and important clinical findings: The patient presented with a 3-day history of fever, cough, and shortness of breath. On examination, his temperature was 39.2 °C, radial pulse 120/min and regular, respiratory rate 25 breaths/min, blood pressure 148/88 mmHg, and oxygen saturation 82% on room air. Chest examination revealed bilateral basal and mid-zone crepitations. Main diagnoses therapeutic interventions and outcomes: The patient tested positive for COVID-19. Electrocardiography and echocardiography results were unremarkable. Laboratory investigations revealed severe haemolytic anaemia with a hemoglobin level of 5.7 g/dL and critical thrombocytopenia with a platelet count of 23 × 10 Conclusion: This case highlights a rare but serious coexistence of long-standing warm-antibody AIHA, COVID-19-associated thrombo-inflammatory disease, and combined venous and arterial thrombosis leading to peripheral digital gangrene. Although the exact mechanism cannot be established with certainty, the clinical course suggests that COVID-19 may have aggravated an already vulnerable haematologic and prothrombotic state, resulting in severe thrombotic complications and tissue loss.