Re: "Endothelitis in COVID-19-positive patients after extremity amputation for acute thrombotic events"

Ilonzo et al reported, in their recent and interesting article, their clinical experience in 4 patients affected by COVID-19 and undergoing major limb amputation secondary to acute irreversible ischemia. On histological examination with hematoxylin/eosin they found inflammatory cells associated with endothelium/apoptotic bodies, mononuclear cells, small vessel congestion, and lymphocytic endotheliitis and concluded that the findings in these patients is more likely an infectious angiitis due to COVID-19. In our experience we have observed numerous cases of venous and arterial thromboembolism not only in the acute phase of COVID-19, but (even more interestingly) even after recovery. Whether SARS-CoV-2 is able to directly attack vascular endothelial cells expressing high levels of ACE2, and then lead to abnormal coagulation and sepsis, still needs to be explored.