{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,27]],"date-time":"2026-02-27T05:10:01Z","timestamp":1772169001608,"version":"3.50.1"},"update-to":[{"DOI":"10.12688\/f1000research.54193.1","type":"new_version","label":"New version","source":"publisher","updated":{"date-parts":[[2021,9,17]],"date-time":"2021-09-17T00:00:00Z","timestamp":1631836800000}}],"reference-count":21,"publisher":"F1000 Research Ltd","license":[{"start":{"date-parts":[[2021,9,17]],"date-time":"2021-09-17T00:00:00Z","timestamp":1631836800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["f1000research.com"],"crossmark-restriction":false},"short-container-title":["F1000Res"],"abstract":"<ns3:p>Hypercoagulation is a hallmark of both the novel coronavirus disease (COVID-19) and type 2 diabetes mellitus (T2DM). It increases the risk for vascular thrombosis, including peripheral artery diseases. Among others, acute limb ischemia (ALI) is one of most common complications that requires immediate and prompt treatments to reduce morbidity and mortality. However, the complex interplay between COVID-19, T2DM and its complications (e.g., diabetic nephropathy), and ALI creates a great challenge in the management of the disease. Here, we present a case of a 59-year-old diabetic female with progressive pain in her left leg in the last five years, which was significantly intensified following COVID-19 diagnosis. Bluish coloration, numbness and functional impairments were observed during examinations with no palpable pulsation on left posterior tibial and dorsalis pedis arteries. The patient also had diabetic nephropathy (stage III), hypoalbuminemia, anemia and a urinary tract infection that complicated the management of the disease. Due to the excruciating pain and the worsening of the limb conditions, right leg revascularization and left leg amputation were performed at day 14 after admission. Following the surgeries, no more pain was observed and patient was discharged for further follow-up at the outpatient clinic.<\/ns3:p>","DOI":"10.12688\/f1000research.54193.2","type":"journal-article","created":{"date-parts":[[2021,9,17]],"date-time":"2021-09-17T10:45:16Z","timestamp":1631875516000},"page":"584","update-policy":"https:\/\/doi.org\/10.12688\/f1000research.crossmark-policy","source":"Crossref","is-referenced-by-count":1,"title":["Case Report: Diabetic nephropathy aggravates the progression and prognosis of COVID-19-associated acute limb ischemia"],"prefix":"10.12688","volume":"10","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3639-2152","authenticated-orcid":false,"given":"Decsa M.","family":"Hertanto","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5730-2013","authenticated-orcid":false,"given":"Henry","family":"Sutanto","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7594-0123","authenticated-orcid":false,"given":"Soebagijo","family":"Adi","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"2560","published-online":{"date-parts":[[2021,9,17]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"851-855","DOI":"10.1111\/1753-0407.13091","article-title":"Diabetes mellitus association with coronavirus disease 2019 (COVID-19) severity and mortality: A pooled analysis.","volume":"12","author":"G Aggarwal","year":"2020","journal-title":"J Diabetes."},{"key":"ref2","doi-asserted-by":"publisher","first-page":"45-57","DOI":"10.1007\/s12185-020-03029-y","article-title":"COVID-19-associated coagulopathy and disseminated intravascular coagulation.","volume":"113","author":"H Asakura","year":"2021","journal-title":"Int J Hematol."},{"key":"ref3","doi-asserted-by":"publisher","first-page":"319-329","DOI":"10.1038\/s41577-021-00536-9","article-title":"Endothelial dysfunction and immunothrombosis as key pathogenic mechanisms in COVID-19.","volume":"21","author":"A Bonaventura","year":"2021","journal-title":"Nat Rev Immunol."},{"key":"ref4","doi-asserted-by":"publisher","first-page":"108383","DOI":"10.1016\/j.diabres.2020.108383","article-title":"Hyperglycemia and COVID-19: What was known and what is really new?","volume":"167","author":"A Ceriello","year":"2020","journal-title":"Diabetes Res Clin Pract."},{"key":"ref5","doi-asserted-by":"publisher","first-page":"10-14","DOI":"10.14797\/mdcj-8-4-10","article-title":"Criticial limb ischemia: epidemiology.","volume":"8","author":"M Davies","year":"2012","journal-title":"Methodist Debakey Cardiovasc J."},{"key":"ref6","doi-asserted-by":"publisher","first-page":"455-462","DOI":"10.2147\/VHRM.S280962","article-title":"D-Dimer, Fibrinogen, and IL-6 in COVID-19 Patients with Suspected Venous Thromboembolism: A Narrative Review.","volume":"16","author":"I Eljilany","year":"2020","journal-title":"Vasc Health Risk Manag."},{"key":"ref7","doi-asserted-by":"publisher","first-page":"2177-2184","DOI":"10.1093\/cvr\/cvaa230","article-title":"Endothelial dysfunction in COVID-19: a position paper of the ESC Working Group for Atherosclerosis and Vascular Biology, and the ESC Council of Basic Cardiovascular Science.","volume":"116","author":"P Evans","year":"2020","journal-title":"Cardiovasc Res."},{"key":"ref8","doi-asserted-by":"publisher","first-page":"540-548","DOI":"10.1007\/s11748-015-0574-3","article-title":"Acute limb ischemia: contemporary approach.","volume":"63","author":"I Fukuda","year":"2015","journal-title":"Gen Thorac Cardiovasc Surg."},{"key":"ref9","doi-asserted-by":"publisher","first-page":"rjaa204","DOI":"10.1093\/jscr\/rjaa204","article-title":"Coagulopathy in COVID-19 infection: a case of acute upper limb ischemia.","volume":"2020","author":"N Galanis","year":"2020","journal-title":"J Surg Case Rep."},{"key":"ref10","doi-asserted-by":"publisher","first-page":"1465-1508","DOI":"10.1016\/j.jacc.2016.11.008","article-title":"2016 AHA\/ACC Guideline on the Management of Patients With Lower Extremity Peripheral Artery Disease: Executive Summary: A Report of the American College of Cardiology\/American Heart Association Task Force on Clinical Practice Guidelines.","volume":"69","author":"M Gerhard-Herman","year":"2017","journal-title":"J Am Coll Cardiol."},{"key":"ref11","doi-asserted-by":"publisher","DOI":"10.20944\/preprints202104.0022.v1","article-title":"Immunomodulation as a Potent COVID-19 Pharmacotherapy: Past, Present and Future.","author":"D Hertanto","year":"2021","journal-title":"Preprints (2021040022)."},{"key":"ref12","doi-asserted-by":"publisher","DOI":"10.1016\/j.hemonc.2020.05.001","article-title":"Acute upper limb ischemia in a patient with COVID-19.","author":"P Kaur","year":"2020","journal-title":"Hematol Oncol Stem Cell Ther."},{"key":"ref13","doi-asserted-by":"publisher","first-page":"e001946","DOI":"10.1161\/CIRCINTERVENTIONS.115.001946","article-title":"Management of Critical Limb Ischemia.","volume":"9","author":"S Kinlay","year":"2016","journal-title":"Circ Cardiovasc Interv."},{"key":"ref14","doi-asserted-by":"publisher","first-page":"377-381","DOI":"10.1253\/circj.71.377","article-title":"Risk factors of peripheral arterial disease and relationship between low ankle - brachial index and mortality from all-cause and cardiovascular disease in Chinese patients with type 2 diabetes.","volume":"71","author":"J Li","year":"2007","journal-title":"Circ J."},{"key":"ref15","doi-asserted-by":"publisher","first-page":"79-86","DOI":"10.1016\/j.fjs.2013.05.002","article-title":"The amputation and mortality rates of diabetic patients with critical limb ischemia: A nationwide population-based follow-up study in Taiwan.","volume":"46","author":"K Liao","year":"2013","journal-title":"Formosan J Surg."},{"key":"ref16","doi-asserted-by":"publisher","first-page":"1655-1661","DOI":"10.1161\/01.CIR.0000089189.70578.E2","article-title":"Diabetes and vascular disease: pathophysiology, clinical consequences, and medical therapy: Part II.","volume":"108","author":"T Luscher","year":"2003","journal-title":"Circulation."},{"key":"ref17","doi-asserted-by":"publisher","first-page":"613-628","DOI":"10.1007\/s10735-020-09915-3","article-title":"COVID-19 and multiorgan failure: A narrative review on potential mechanisms.","volume":"51","author":"T Mokhtari","year":"2020","journal-title":"J Mol 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Associated With Decreased Limb Survival in Patients With Critical Limb Ischemia: Pooled Data From Two Randomized Controlled Trials.","volume":"39","author":"M Spreen","year":"2016","journal-title":"Diabetes Care."}],"container-title":["F1000Research"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/f1000research.com\/articles\/10-584\/v2\/xml","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/f1000research.com\/articles\/10-584\/v2\/pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/f1000research.com\/articles\/10-584\/v2\/iparadigms","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,11,20]],"date-time":"2021-11-20T23:10:13Z","timestamp":1637449813000},"score":1,"resource":{"primary":{"URL":"https:\/\/f1000research.com\/articles\/10-584\/v2"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,9,17]]},"references-count":21,"URL":"https:\/\/doi.org\/10.12688\/f1000research.54193.2","relation":{"has-review":[{"id-type":"doi","id":"10.5256\/f1000research.77605.r94693","asserted-by":"subject"},{"id-type":"doi","id":"10.5256\/f1000research.77605.r94693","asserted-by":"object"}]},"ISSN":["2046-1402"],"issn-type":[{"value":"2046-1402","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,9,17]]},"assertion":[{"value":"Indexed","URL":"https:\/\/f1000research.com\/articles\/10-584\/v2#article-reports","order":0,"name":"referee-status","label":"Referee status","group":{"name":"current-referee-status","label":"Current Referee Status"}},{"value":"10.5256\/f1000research.77605.r94693, Ketut Suastika, Faculty of Medicine, Sanglah General Hospital, Udayana University, Bali, Indonesia, 20 Sep 2021, version 2, indexed","URL":"https:\/\/f1000research.com\/articles\/10-584\/v2#referee-response-94693","order":0,"name":"referee-response-94693","label":"Referee Report","group":{"name":"article-reports","label":"Article Reports"}},{"value":"10.5256\/f1000research.57653.r92346, Joyce Bernardi, Biomedical Research and Translational Medicine, Masonic Medical Research Institute, Utica, NY, USA, 01 Sep 2021, version 1, indexed","URL":"https:\/\/f1000research.com\/articles\/10-584\/v1#referee-response-92346","order":1,"name":"referee-response-92346","label":"Referee Report","group":{"name":"article-reports","label":"Article Reports"}},{"value":"<b>Henry Sutanto<\/b>; \n<i>Posted: 10 Sep 2021<\/i>; \n<i>The authors describe in detail the case of a 59-year-old female with T2DM, presenting with bilateral acute limb ischemia that aggravated after COVID-19 infection. A revascularization of the right lower limb through thrombectomy and amputation of the necrotic left lower limb have been performed. The manuscript highlights how the presence of COVID-19 infection and other comorbidities is critical in the evolution of ALI and how a timely intervention is important to reduce morbidity and mortality. The background of the case is well described, together with an extensively detailed description of the progression, diagnosis, and treatment. In the discussion the authors give a good overview of what is known about the interaction between COVID-19 and other comorbidities, such as T2DM and ALI, pointing out the importance of a prompt intervention.<\/i>  \n<b>Response: <\/b>We would like to thank the reviewer for the time and willingness to assess the quality of our manuscript.","URL":"https:\/\/f1000research.com\/articles\/10-584\/v2#referee-comment-7140","order":2,"name":"referee-comment-7140","label":"Referee Comment","group":{"name":"article-reports","label":"Article Reports"}},{"value":"The author(s) declared that no grants were involved in supporting this work","order":3,"name":"grant-information","label":"Grant Information"},{"value":"This is an open access article distributed under the terms of the Creative Commons Attribution Licence, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.","order":0,"name":"copyright-info","label":"Copyright"}]}}