A COVID-19 Patient with Simultaneous Renal Infarct, Splenic Infarct and Aortic Thrombosis during the Severe Disease

Abstract

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection has been associated with a high incidence of arterial and venous thrombotic complications. However, thromboembolic events in unusual sites such as limb and visceral arterial ischemia are reported rarely in the literature. Herein, we describe a rare case of a patient with severe coronavirus disease 2019 (COVID-19) infection who experienced severe abdominal pain during the hospitalization and presented simultaneously renal artery, splenic artery and vein as well as aortic thrombi despite prophylactic antithrombotic treatment. Information about his follow-up post discharge is also provided. This case report raises significant clinical implications regarding the correct dose of antithrombotic treatment during the acute phase of the severe COVID-19 infection and highlights the need for incessant vigilance in order to detect thrombosis at unusual sites as a possible diagnosis when severe abdominal pain is present in severe COVID-19 patients.

Splenic Artery Infarct Requiring Surgery: A Rare Complication of COVID-19 Infection

“…There is no consensus regarding the best therapy for arterial occlusion, and different authors have used a variety of medications for treating arterial infarcts after coronavirus infection [21,28]. However, it is crucial to determine the best therapy for acute arterial thrombosis in which not only the appropriate anticoagulant treatment regimen but also the correct dose is essential to improve prognosis, relieve symptoms, and significantly reduce mortality and disability [21,40]. In addition, splenectomy is a risk factor for overwhelming bacterial sepsis.…”

“…In the case of a SARS-CoV-2 infection, endothelial integrity and normal venous blood flow may be dysregulated due to endothelial or vascular injury, resulting in venous stasis [ 8 , 21 – 23 ]. Additionally, the cytokine storm that accompanies the response to coronavirus infection may activate the coagulation system, causing systemic inflammation, endothelial cell activation, and the release of tissue factors, predisposing the tissue to thrombosis [ 2 , 6 , 17 , 20 , 22 ].…”

“…Routine use of LMWH should be followed in patients with SARS-CoV-2 infection, although some authors consider this controversial [ 11 , 27 , 31 , 38 , 39 ]. There is no consensus regarding the best therapy for arterial occlusion, and different authors have used a variety of medications for treating arterial infarcts after coronavirus infection [ 21 , 28 ]. However, it is crucial to determine the best therapy for acute arterial thrombosis in which not only the appropriate anticoagulant treatment regimen but also the correct dose is essential to improve prognosis, relieve symptoms, and significantly reduce mortality and disability [ 21 , 40 ].…”

“…Furthermore, from a brief review of the literature, we observed that antithrombotic treatment with LMWH, ASA, and other anticoagulants results in improvement in splenic artery infarcts, causes recanalization of the splenic artery, and that splenectomy is required only in the case of clinical deterioration of the patient [ 20 , 30 , 31 , 33 , 41 , 47 ]. While we await further data from clinical trials regarding treatment guidelines, a reasonable approach would be to continue with regular-dose thromboprophylaxis in all COVID-19 patients and to provide therapeutic anticoagulation in patients with confirmed thrombotic events [ 2 , 14 , 21 , 24 , 35 , 39 ].…”

Aortic Thrombosis Associated with Three Types of COVID-19 Vaccine

“…One study suggests that the occurrence of the synchronous damage involving both the lumen surface (endothelial dysfunction, endotheliitis, and endothelial detachment) and the adventitia (inflammation and occlusive thrombosis of vasa vasorum) could be the key points related to the fatal outcome in patients with SARS-CoV-2 [ 13 ]. Thromboembolic events in unusual locations (thrombi in the aorta with visceral arterial ischemic and in the limbs) are rarely reported in the literature [ 14 ].…”