Angioma serpiginosum (AS) has emerged as a rare post-COVID-19 acquired vasculopathy in a 25-year-old woman, according to a recent case report published in medical literature. The patient developed numerous bilateral red-violaceous serpiginous and reticular patches across all extremities one month after a SARS-CoV-2 infection, exhibiting atypical adult onset and bilateral symmetry that expand the known spectrum of COVID-19-associated vascular sequelae.
Clinical Presentation of Post-COVID Angioma Serpiginosum
The patient, an otherwise healthy 25-year-old woman, presented with approximately 40 fixed, irregular red patches on the anterolateral surfaces of her arms and legs, according to the case documentation. These lesions appeared abruptly about one month following her first episode of COVID-19. Over a three-year follow-up period, the patches remained unchanged in size, distribution, and number. They proved to be asymptomatic, nontender, and notable for sparing the flexural surfaces while concentrating on the extensor surfaces of the knees and elbows with irregular, stellate borders.
Did you know? While angioma serpiginosum typically presents in childhood or adolescence as a unilateral eruption on the legs and buttocks, this patient’s case is distinguished by its onset in young adulthood and a bilaterally symmetric distribution across all extremities.
Dermatological Findings and Biopsy Results
Diagnostic evaluation included two punch biopsy specimens obtained from the left thigh, according to the clinical report. H&E sections revealed mildly dilated superficial dermal capillaries accompanied by sparse lymphocytic inflammatory infiltrates. However, the tissue showed no evidence of vascular occlusion, neutrophilia, leukocytoclasia, fibrin deposition, or vessel wall damage. A periodic acid-Schiff stain ruled out fungal involvement with a negative result, while direct immunofluorescence studies tested negative for antibodies against IgG, IgA, IgM, fibrinogen, and C3.
Laboratory testing yielded normal results across a comprehensive panel. Complete blood counts, comprehensive metabolic panels, antinuclear antibodies, antineutrophil cytoplasmic antibodies, C-reactive protein, erythrocyte sedimentation rates, rheumatoid factor, lupus anticoagulant, anticardiolipin antibodies, and coagulation studies all returned within normal limits.
Differential Diagnosis and Treatment Considerations
Clinicians differentiated the condition from other vascular and purpuric dermatoses based on physical and histological traits. Direct pressure failed to cause blanching, but injecting lidocaine with epinephrine into an involved area triggered immediate blanching and temporary erythema resolution, cementing the diagnosis of angioma serpiginosum. Livedo racemosa was deemed unlikely due to the absence of thrombosis on histopathology, while livedo reticularis was ruled out because those lesions typically fluctuate with temperature rather than remaining fixed. Leukocytoclastic vasculitis was also excluded given the lack of vessel wall damage.
Regarding management, treatment is generally not necessary for angioma serpiginosum since the condition is benign. When patients seek intervention for cosmetic purposes, pulsed dye laser (PDL) therapy serves as the treatment of choice, though potassium titanyl phosphate laser and intense pulsed light therapy also offer efficacy, according to clinical studies. The patient in this case ultimately declined pulsed dye laser therapy.
Frequently Asked Questions
What is angioma serpiginosum?
Angioma serpiginosum is an uncommon, benign capillary malformation characterized by nonblanching, red-purple macules arranged in a serpiginous or gyrate pattern.
How does COVID-19 relate to this vascular condition?
The close temporal association between the patient’s SARS-CoV-2 infection and the sudden appearance of the lesions suggests the virus may have triggered an acquired anomalous vasculopathy, expanding known cutaneous vascular sequelae.
Is angioma serpiginosum painful?
In this documented case, the lesions were asymptomatic and nontender, remaining stable over a three-year observation period.
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