Introduction:
The common aetiologias of gangrene are atherosclerosis and diabetes mellitus, while human immunodeficiency virus (HIV) can be one of additional various pathologic conditions. The risk of peripheral arterial disease is higher in HIV-infected population. Almost every pattern and type of vasculitis were described in HIV people, but widespread digital ischemic changes and gangrene of the hands and feet are uncommon presentations.

Case presentation:
We presented a case of a 33-year-old patient from HIV pediatric Romanian cohort, homeless, previous smoker, and drug user. He was diagnosed HIV-positive 28 years ago, and expe­rienced severe opportunistic diseases and multiple failures of antiretroviral treatments. Clinical exami­nation revealed blackish discoloration in both legs and feet, and severe immunosuppression. Debriding, necrotomy, and lavage of the legs were done, and he received directly observed antiretrovirals. The patient was infected with COVID-19. After 24 weeks, the viral load was undetectable, CD4 count increased, and no necrosis observed, but he is totally care-dependent.

Conclusions:
HIV people are vulnerable during COVID-19 pandemic due to the limited access to healthcare and high-risk of COVID-19-associated infections. Gangrene is a rare condition associated with HIV demonstrating poor functional prognosis, even with viral suppression achieved after antiretroviral treatment.