Incidental and Asymptomatic Splenic Infarction and Infrarenal Thrombus in a COVID-19 Patient.
covid-19
hypercoagulable state
infrarenal thrombus
splenic infarction
splenic thrombus
Journal
Cureus
ISSN: 2168-8184
Titre abrégé: Cureus
Pays: United States
ID NLM: 101596737
Informations de publication
Date de publication:
Jul 2022
Jul 2022
Historique:
accepted:
04
07
2022
entrez:
8
8
2022
pubmed:
9
8
2022
medline:
9
8
2022
Statut:
epublish
Résumé
The cytokine storm associated with coronavirus disease 2019 (COVID-19) triggers a hypercoagulable state leading to venous and arterial thromboembolism. Lab findings associated with this phenomenon are elevated D-dimer, fibrinogen, C-reactive protein (CRP), ferritin, and procalcitonin. We present the case of a 66-year-old male with dyslipidemia who was diagnosed with COVID-19 with worsening shortness of breath, myalgia, and loss of taste. Physical examination was remarkable for crackles with diminished lung sounds and use of his accessory muscles. Labs showed normal white blood cell count, D-dimer of 1.42 mg/L, ferritin of 961 ng/mL, lactate dehydrogenase (LDH) of 621 U/L, and CRP of 2.1 mg/dL. Chest X-ray showed atypical pneumonitis with patchy abnormalities. He required oxygen supplementation with fraction of inspired oxygen of 100% proning as tolerated. He received remdesivir, ceftriaxone, azithromycin, dexamethasone, prophylactic enoxaparin, and a unit of plasma therapy. His D-dimer had increased from 1.65 to 3.51 mg/L with worsening dyspnea. At this time, computed tomography angiogram (CTA) of the chest showed extensive ground-glass opacities and a 2.4 × 1.9 × 1.3 cm distal thoracic aortic intraluminal thrombus. He was started on a heparin drip. A follow-up CTA of the aorta showed thrombus or hypoattenuation within the splenic artery and wedge-shaped areas extending from the hilum with possible infarction and a 6 mm thrombus in the infrarenal abdominal aorta. He was transitioned to enoxaparin 1 mg/kg twice daily. He remained asymptomatic from his splenic infarction. This case adds more insight to splenic infarction associated with COVID-19 in addition to the 32 reported cases documented thus far. Management of thromboembolism includes a therapeutic dose of anticoagulation. To prevent thromboembolism, prophylactic anticoagulation is recommended for those hospitalized with COVID-19.
Identifiants
pubmed: 35936145
doi: 10.7759/cureus.26555
pmc: PMC9348832
doi:
Types de publication
Case Reports
Langues
eng
Pagination
e26555Informations de copyright
Copyright © 2022, Childers et al.
Déclaration de conflit d'intérêts
The authors have declared that no competing interests exist.
Références
Ann Med Surg (Lond). 2021 Aug;68:102646
pubmed: 34341687
Lancet. 2020 Aug 1;396(10247):320-332
pubmed: 32682491
J Investig Med High Impact Case Rep. 2022 Jan-Dec;10:23247096211063332
pubmed: 34984948
J Crit Care. 2020 Oct;59:32-34
pubmed: 32512349
BMJ Case Rep. 2021 Jul 28;14(7):
pubmed: 34321271
Eur Rev Med Pharmacol Sci. 2021 Feb;25(3):1680-1683
pubmed: 33629338
Eur Heart J Case Rep. 2020 Dec 25;5(1):ytaa488
pubmed: 33542975
Ann Med Surg (Lond). 2021 Nov;71:102935
pubmed: 34659749
Emerg Infect Dis. 2020 Aug;26(8):1926-1928
pubmed: 32396504
TH Open. 2021 Feb 16;5(1):e81-e83
pubmed: 33615124
Eur Radiol. 2021 Oct;31(10):7363-7370
pubmed: 33864140
Neurologist. 2022 May 01;27(3):143-146
pubmed: 34855656
Chest. 2020 Sep;158(3):1143-1163
pubmed: 32502594
Thromb Res. 2020 Jul;191:145-147
pubmed: 32291094
J Am Coll Cardiol. 2020 Jun 16;75(23):2950-2973
pubmed: 32311448
Front Med (Lausanne). 2021 Nov 05;8:698627
pubmed: 34805195
Radiol Case Rep. 2021 May;16(5):999-1004
pubmed: 33619439
Clin Chem Lab Med. 2020 Jun 25;58(7):1116-1120
pubmed: 32172226
Clin Imaging. 2021 Nov;79:12-19
pubmed: 33865171
Thromb Res. 2020 Aug;192:75-77
pubmed: 32425264
QJM. 2020 Dec 1;113(12):907-908
pubmed: 33000142
Eur J Case Rep Intern Med. 2020 Jun 03;7(7):001747
pubmed: 32665933
Drugs. 2020 Oct;80(15):1553-1562
pubmed: 32803670
Int J Cardiol. 2021 Jan 15;323:281-284
pubmed: 32918938
Am J Med Sci. 2021 Oct;362(4):418-423
pubmed: 34161825
Cureus. 2021 Feb 1;13(2):e13065
pubmed: 33680607
Int J Surg Case Rep. 2020;75:211-213
pubmed: 32959008
Radiol Case Rep. 2022 Mar 02;17(5):1402-1406
pubmed: 35242265
Infez Med. 2020 Dec 1;28(4):611-615
pubmed: 33257638
Case Rep Crit Care. 2020 Sep 4;2020:8880143
pubmed: 32934849
Healthcare (Basel). 2022 Jan 13;10(1):
pubmed: 35052313
Blood. 2020 Jul 23;136(4):489-500
pubmed: 32492712