{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,9]],"date-time":"2026-04-09T04:49:25Z","timestamp":1775710165614,"version":"3.50.1"},"reference-count":44,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,4,9]],"date-time":"2026-04-09T00:00:00Z","timestamp":1775692800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Med."],"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Main symptoms and important clinical findings<\/jats:title>\n                    <jats:p>The patient presented with a 3-day history of fever, cough, and shortness of breath. On examination, his temperature was 39.2\u202f\u00b0C, radial pulse 120\/min and regular, respiratory rate 25 breaths\/min, blood pressure 148\/88\u202fmmHg, and oxygen saturation 82% on room air. Chest examination revealed bilateral basal and mid-zone crepitations.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Main diagnoses, therapeutic interventions, and outcomes<\/jats:title>\n                    <jats:p>\n                      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\u202fg\/dL and critical thrombocytopenia with a platelet count of 23\u202f\u00d7\u202f10\n                      <jats:sup>3<\/jats:sup>\n                      \/\u03bcL. High-resolution computed tomography (CT) of the chest revealed bilateral multilobar ground-glass opacities with subpleural atelectatic bands, interlobular septal thickening, and a crazy-paving pattern, consistent with COVID-19 pneumonia. He was treated with non-invasive ventilation, corticosteroids, intravenous immunoglobulin, therapeutic anticoagulants, insulin glargine, and moxifloxacin. During admission, he received 6\u202funits of packed RBCs and 34\u202funits of platelets. His respiratory condition improved after 1\u202fweek, and therefore non-invasive ventilation was discontinued and he became stable on room air, with modest improvement in hemoglobin and platelet counts. Follow-up CT pulmonary angiography demonstrated a bilateral peripheral pulmonary embolism with regressing COVID-19 pneumonia. CT angiography of the upper extremities showed complete cessation of radial artery flow at both wrists. The patient subsequently developed dry gangrene affecting the right thumb and index finger and the distal parts of the left thumb and index finger. Six weeks post-admission, he underwent surgical amputation of the gangrenous digits.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fmed.2026.1816083","type":"journal-article","created":{"date-parts":[[2026,4,9]],"date-time":"2026-04-09T04:11:13Z","timestamp":1775707873000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Case Report: COVID-19-associated gangrene of fingers in a patient with autoimmune haemolytic anaemia"],"prefix":"10.3389","volume":"13","author":[{"given":"Mahmoud M.","family":"Ramadan","sequence":"first","affiliation":[{"name":"Department of Clinical Sciences, College of Medicine, University of Sharjah","place":["Sharjah, United Arab Emirates"]},{"name":"Department of Cardiology, Faculty of Medicine, Mansoura University","place":["Mansoura, Egypt"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mohammed","family":"Elmahal","sequence":"additional","affiliation":[{"name":"Department of Diabetes and Endocrinology, Queen Mary University of London","place":["London, United Kingdom"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Moustafa M.","family":"Madkour","sequence":"additional","affiliation":[{"name":"College of Pharmacy, University of Sharjah","place":["Sharjah, United Arab Emirates"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mohamed A.","family":"Eladl","sequence":"additional","affiliation":[{"name":"Department of Basic Sciences, College of Medicine, University of Sharjah","place":["Sharjah, United Arab Emirates"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Abdelraouf M.","family":"Abdelkarim","sequence":"additional","affiliation":[{"name":"Department of Clinical Sciences, College of Medicine, University of Sharjah","place":["Sharjah, United Arab Emirates"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Zaid M.","family":"Abdelkarim","sequence":"additional","affiliation":[{"name":"Department of Clinical Sciences, College of Medicine, University of Sharjah","place":["Sharjah, United Arab Emirates"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mohammed A.","family":"Al-Shura","sequence":"additional","affiliation":[{"name":"Department of Clinical Sciences, College of Medicine, University of Sharjah","place":["Sharjah, United Arab Emirates"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Wael A.","family":"Hassan","sequence":"additional","affiliation":[{"name":"Department of Clinical Sciences, College of Medicine, University of Sharjah","place":["Sharjah, United Arab Emirates"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ahmed","family":"Lamey","sequence":"additional","affiliation":[{"name":"Department of General Surgery, Faculty of Medicine, Kafrelsheikh University","place":["Kafrelsheikh, Egypt"]}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2026,4,9]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"351","DOI":"10.1016\/j.mcna.2016.09.007","article-title":"Autoimmune hemolytic anemia","volume":"101","author":"Liebman","year":"2017","journal-title":"Med Clin North Am"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"353","DOI":"10.1016\/j.hoc.2021.12.003","article-title":"Complications of autoimmune hemolytic anemia","volume":"36","author":"Shah","year":"2022","journal-title":"Hematol Oncol Clin North Am"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"385","DOI":"10.1007\/s00005-013-0232-3","article-title":"Current approaches for the treatment of autoimmune hemolytic anemia","volume":"61","author":"Jaime-P\u00e9rez","year":"2013","journal-title":"Arch Immunol Ther Exp"},{"key":"ref4","first-page":"20","article-title":"COVID-19 pandemic: from origins to outcomes. 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