Acute Upper Limb Ischemia Due To Arterial Thrombosis in a Mild COVID-19 Patient: A Case Report

Abstract

Coronavirus disease 2019 (COVID-19) which has now been declared a global pandemic, initially began as a pneumonia caused by novel coronavirus called severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) in Wuhan, China. COVID-19, in addition to respiratory symptoms, is also being recognized to have different manifestations including myocardial infarction, seizures, meningitis, diarrhea, and coagulopathy. Here we report a case of a 75-year-old female patient with mild COVID-19 who later developed acute limb ischemia due to arterial thrombosis to highlight that, contrary to the association of coagulopathy with severe COVID-19, thrombosis can also occur in patients with mild COVID-19

Upper extremity arterial thromboembolism in a patient with severe COVID-19 pneumonia: A case report

“…In these cases, revascularization was achieved with anticoagulant therapy or after thrombectomy. [7,13,[17][18][19] In the present case, although arterial thromboembolectomy was performed twice, revascularization could not be achieved and amputation was required at the forearm level.…”

Isolated Basilic Vein Thrombosis as a Rare Presentation of COVID-19 in a Young Patient

“…We have also seen multiple reports of extensive microthrombi culminating in PE, stroke, or myocardial infarction. Although arterial thrombosis causing acute upper limb ischemia in the setting of COVID-19 infection has been reported [ 7 , 8 ], isolated upper-extremity DVT is a rare case presentation [ 5 ]. Our report aims to highlight the possibility of an insidious onset of upper extremity DVT in the context of COVID-19 infection with less severe manifestations, in a young patient.…”

Failure of Major Upper Extremity Replantation Due to COVID-19-Related Arterial Thrombosis

“…COVID-19, which causes "cytokine storm" and endothelial damage by increasing the expression of proinflammatory cytokines such as interleukin (IL)-6 and tumor necrosis factor-alpha (TNF-α), along with inflammatory chemokines, predisposes to deep vein thromboembolism or arterial thrombosis [9,10]. Additionally, activation of angiotensin-converting enzyme-2 receptor and macrophage in the vascular endothelium can lead to this condition [11].…”

“…In addition, too many COVID-19related venous thromboembolisms in the early period, stroke, acute coronary syndrome, or extremity gangrenes due to arterial thrombosis have also been reported [13][14][15]. Hanif et al [11] and Shao et al [16] have presented acute upper limb ischemia due to COVID-19 and stated that arterial thrombosis can be the first symptom of patients in COVID-19. Although it has been reported to have a 3.7% incidence in intensive care patients, the true incidence of arterial thrombosis in both upper and lower extremities is unknown.…”

“…Although it has been reported to have a 3.7% incidence in intensive care patients, the true incidence of arterial thrombosis in both upper and lower extremities is unknown. Therefore, anticoagulant and antiaggregant drugs are used in the treatment of COVID-19 [9][10][11][12]. After COVID-19 infection, the risk of increased thrombosis in the proximal vessels is reported by Goldman et al [13].…”