Perniolike lesions and coagulopathy in a patient with COVID-19 infection

Perniolike lesions of the toes that are caused by coronavirus disease 2019 (COVID-19), known as COVID toes, have recently been reported around the world.1, 2, 3 The etiology and optimal management remain largely unknown. We present the case of a patient with COVID toes in association with acute severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, in whom a comprehensive hematologic evaluation revealed a striking elevation of factor VIII activity and von Willebrand factor level, suggesting that endothelial dysfunction may be associated with this cutaneous manifestation of coronavirus infection.