Delayed manifestation of extensive COVID-19-associated coagulopathy in high-risk patient

Abstract

COVID-19 is an infectious disease caused by the novel coronavirus. It presents as an acute respiratory illness, however, it also affects multiple other organ systems. One such unique manifestation is systemic coagulopathy involving arterial and venous systems. We present a 29-year-old woman with Hodgkin’s lymphoma, who was diagnosed with COVID-19 infection prior to initiating chemotherapy. Two months after resolution of symptoms and testing negative for COVID-19, she presented with multiple acute thromboembolic complications of the infection, including bilateral jugular venous thrombosis, right atrial clot and arterial emboli in the brain resulting in cerebrovascular injury. These were thought to be delayed manifestations of the systemic coagulopathy secondary to infection. Also, some of these thromboembolic phenomena occurred while the patient was on anticoagulation, which emphasises the extensive hyperinflammatory state caused by the virus. This case highlights the importance of thromboprophylaxis especially in high-risk patients with this infection.

Developmental venous anomaly thrombosis in a patient with coronavirus disease 2019-associated hypercoagulability: illustrative case

“…6 Our patient's mild respiratory symptoms are consistent with reports of severe thromboembolism occurring in mild COVID-19 infections. 4,7 This case represents the second report of an association between DVA thrombosis preceding COVID-19 infection and underscores the lack of correlation between COVID-19 severity and risk of DVA thrombosis, similar to that of CVST. Our patient's presentation 5 weeks after COVID-19 symptom onset suggests delayed DVA thrombosis in the setting of a protracted systemic viral-induced hypercoagulable state following the infectious period.…”

“…Our patient’s presentation 5 weeks after COVID-19 symptom onset suggests delayed DVA thrombosis in the setting of a protracted systemic viral-induced hypercoagulable state following the infectious period. 7 There have been reports of sustained prothrombotic changes occurring up to 4 months after the infectious period in COVID-19 patients. 7 , 8 Complications associated with DVA thrombosis emphasize the importance of draining vein preservation in the management of this entity.…”

“… 7 There have been reports of sustained prothrombotic changes occurring up to 4 months after the infectious period in COVID-19 patients. 7 , 8 Complications associated with DVA thrombosis emphasize the importance of draining vein preservation in the management of this entity.…”

COVID-19 complicated by immune thrombocytopaenic purpura and internal jugular vein thrombosis

“…Bilateral jugular vein thrombosis was reported in a 29-year-old woman with Hodgkin's lymphoma. 22 She had tested positive for COVID-19 2 months prior and fully recovered from COVID-19 symptoms. She presented with several thromboembolic complications including right atrial clot, arterial brain emboli and bilateral jugular venous thrombosis.…”

Post-COVID-19 rhinocerebral mucormycosis, a life-threatening event in the background of immunosuppressive condition: A case report

“…In addition to the acute complications of pulmonary disease, it is associated with extrapulmonary systemic sequels such as myocardial infarction, hemorrhage, coagulation disorders, and even ischemic stroke (4)(5)(6). In this regard, the evidence of acute and even delayed onset of COVID-19-related complications has been reported months after recovery and discharge (7). The occurrence of viral and even fungal meningitis, as well as intracranial hemorrhage, are some of the consequences of the disease, which, despite being rare, is associated with high mortality (8, 9).…”