Clostridium Difficile and COVID-19: Novel Risk Factors for Acute Portal Vein Thrombosis

Abstract

The COVID-19 pandemic has created an unprecedented global health care crisis. COVID-19 patients are found to have increased thrombotic risk. Despite being on prophylactic anticoagulation, many develop serious arterial and venous thromboembolic events. Emerging reports indicate COVID-19 may be considered a novel risk factor for portal vein thrombosis. Although, intra-abdominal infections are identified as risk factors, clostridium difficile colitis has not been typically seen as a risk factor for PVT. We report a case of an elderly female with a recent diagnosis of COVID-19 and no prior history of cirrhosis or malignancy who presented with diarrhea due to clostridium difficile infection. She developed sudden onset severe abdominal pain during the course of hospitalization. Acute portal vein thrombosis was identified on CT imaging of the abdomen, and she improved well with therapeutic anticoagulation. Acute portal vein thrombosis usually results from a combination of local and systemic prothrombotic risk factors. The combination of local infection by clostridium difficile and COVID-19 coagulopathy led to development of portal vein thrombosis in our patient. To the best of our knowledge, this is the first case of portal vein thrombosis reported in a patient with clostridium difficile infection in the setting of COVID-19 coagulopathy. During the current pandemic, clinicians should strongly consider abdominal imaging in patients presenting with abdominal pain due to clostridium difficile infection in the setting of COVID-19 to rule out complications such as portal vein thrombosis. Early diagnosis and treatment of portal vein thrombosis prevent complications of portal hypertension and intestinal infarctions.

Diagnostic, Prognostic, and Therapeutic Roles of Gut Microbiota in COVID-19: A Comprehensive Systematic Review

“…There is a dominancy of genus Clostridium in patients with COVID-19 (Gu et al, 2020b;Zuo et al, 2020a;Cao et al, 2021;Yamamoto et al, 2021). The increase in Clostridium ramosum and Clostridium hathewayi is associated with the disease severity which may be a risk factor of acute portal vein thrombosis (Zuo et al, 2020;Rokkam et al, 2021). Clostridium difficile may complicate COVID-19 and worsen the GI symptoms (Ferreira et al, 2020;Oba et al, 2020;Sandhu et al, 2020;Khanna and Kraft, 2021).…”

Portal Vein Thrombosis Might Develop by COVID-19 Infection or Vaccination: A Systematic Review of Case-Report Studies

“…Another categorization demonstrates that in the chronic form of PVT, patients generally develop symptoms such as varicose veins and hypersplenism that are associated with portal hypertension. Nevertheless, in the acute form, local and systemic prothrombotic factors are the main reasons for this complication ( 9 , 11 ). The clinical presentations of acute PVT, show a wide spectrum of asymptomatic indications to severe intestinal ischemia and infarction ( 12 ).…”

COVID-19 and Fulminant Clostridium difficile Colitis Co-Infection

“…CDI is a challenging disease with a recurrence rate of 15-20% and mortality rate of 5% [9] . While there is a general paucity of data regarding CDI in COVID-19 patients, we found three case reports which make for interesting comparisons with our patient [10][11][12] . All of these cases, plus the nine subjects discussed by Sandhu et al, emerged in the setting of extensive use of broad-spectrum antibiotics leading to severe CDI, as illustrated in Table 1 [13] .…”