Late diagnosis of COVID-19 in a 34-year-old man in a hypercoagulable state: A case report

Abstract

Background: Late diagnosis of COVID-19 in young patients in a hypercoagulable state can cause a high mortality rate. Clinical manifestations of COVID-19 include respiratory and extrapulmonary symptoms such as a hypercoagulable state, increased transaminase enzymes, and multiple-organ failure. Case and outcomes: A 34-year-old male presented to the emergency room after 3 days of high fever, weakness, and flatulence. The patient had thrombocytopenia and elevated liver transaminase enzymes and was initially diagnosed with dengue hemorrhagic fever. He was given hydration intravenous fluids, oxygen, antipyretic, and hepatoprotector. On day 4, the patient was diagnosed with COVID-19 and received therapy to decrease the Alanine transaminase and Aspartate transaminase levels. While waiting for outsourced D dimer and prothrombin time results, the patient was given low molecular weight heparin (LMWH) on day 5. On day 13, his condition deteriorated with cephalgia and shortness of breath, but the patient's family refused intubation. The chest CT scan revealed large ground-glass opacities in both lungs. The patient was given additional medications, such as Meropenem, Dexamethasone, and Remdesivir. On day 15, the patient passed away. Discussion: Intermediate LMWH dosage seems to be associated with a lower mortality incidence than standard Deep Vein Thrombosis (DVT) prophylaxis in hospitalized COVID-19 patients. However, due to the late COVID-19 diagnosis, the patient was not given LMWH at the beginning of treatment. Conclusion: A hypercoagulable state is partly responsible for the high mortality rate of COVID-19 patients. Early detection and management of the hypercoagulable state, including the use of LMWH, can decrease the severity of COVID-19 symptoms.

Late diagnosis of COVID-19 and hypercoagulable state

“…We would like to share ideas on the publication “Late diagnosis of COVID-19 in a 34-year-old man in a hypercoagulable state: A case report [ 1 ].” According to Desdiani, the increased mortality rate of COVID-19 patients is mostly due to a hypercoagulable state, and early recognition and therapy of the hypercoagulable state, including the use of LMWH, can lessen the severity of COVID-19 symptoms [ 1 ]. The patient was first diagnosed with dengue hemorrhagic fever and had thrombocytopenia and increased liver transaminase tests.…”

Letter to the Editor: Response to late diagnosis of COVID-19 and hypercoagulable state

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I would like to give my response to Mungmunpuntipantip and Wiwanitkit's Letter to the Editor, "Late diagnosis of COVID-19 and hypercoagulable state" [1], which cited my paper "Late diagnosis of COVID-19 in a 34-yearold man in a hypercoagulable state: A case report" [2].Based on the case, this patient was initially treated by an internist in a small hospital and was diagnosed and treated as Dengue Hemorrhagic Fever patient; however, there was no improvement and the condition even worsened, oxygen saturation decreased, then the patient was referred to a larger hospital. After a Polymerase Chain Reaction (PCR) examination, the results were positive, and then the patient was diagnosed and treated as COVID-19 patient, but because the patient already had a severe hypercoagulable condition, the patient could not be helped [3][4][5].

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“…I would like to give my response to Mungmunpuntipantip and Wiwanitkit’s Letter to the Editor, “Late diagnosis of COVID-19 and hypercoagulable state” [ 1 ], which cited my paper “Late diagnosis of COVID-19 in a 34-year-old man in a hypercoagulable state: A case report” [ 2 ].…”