Life and Limb: a Case of COVID-19-Associated Multisystem Thrombosis and Review of the Literature

Demir, Koray; Simard, Camille; Lipes, Jed; Yang, Stephen Su

doi:10.1007/s11606-020-06496-5

Cited by 4 publications

(3 citation statements)

References 34 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The interaction between inflammation and the coagulation system is probably one factor contributing to their development. [18] In our case, the patient developed left superficial femoral vein thrombosis during the hospital stay. It could have been due to multiple factors, including a family history of factor V Leiden mutation and prothrombin gene mutation, immobilization during a hospital stay, or COVIDinduced factors.…”

Section: Discussionmentioning

confidence: 58%

Atypical immunologic manifestations of COVID-19: A case report and a comprehensive review

Shah

Patel²,

Oza

et al. 2022

Preprint

View full text Add to dashboard Cite

Introduction: COVID-19 usually presents with classic signs and symptoms, but it can involve multiple systems in atypical cases. SARS-CoV-2 has a complex interaction with the host immune system leading to atypical manifestations. Case Presentation: In our case, a 32-year-old male patient presented with fatigue, sores on hands and feet, headache, productive cough with blood-tinged mucus, conjunctival hyperemia, purpuric rash on hands and feet, and splinter hemorrhages of fingernails for two weeks. The patient’s SARS-CoV-2 antigen and PCR test were positive. Chest x-ray showed mixed density perihilar opacities in both lungs. Computed tomography of the chest showed extensive airspace opacities in both lungs, suggesting COVID-19 multifocal, multilobar pneumonitis. A renal biopsy indicated limited thrombotic microangiopathy and tubulointerstitial nephritis, for which he was started on steroids, and his renal functions gradually improved. He tested positive for C-ANCA during an immune workup. He was discharged with a steroid taper for nephritis. Once the taper reached less than 10 mg/day, he developed acute scleritis and a new pulmonary cavitary lesion of 6 centimeters. The biopsy via bronchoscopy revealed acute inflammatory cells with hemosiderin-laden macrophages. He was restarted on systemic steroids for scleritis after failing topical steroids, which incidentally also reduced the size of the cavitary lesion, indicating an immune component. Conclusions: Our case demonstrates the involvement of kidneys and vasculitis of the skin, sclera, and lungs by COVID-19. The patient’s symptoms were not explained by any diseases other than COVID-19. Atypical cases of COVID-19 disease with multifocal systemic symptoms involving the skin, sclera, lungs, and kidneys should be high on differentials. Early recognition and intervention may decrease hospital stays and morbidity.

show abstract

Section: Discussionmentioning

confidence: 58%

Atypical immunologic manifestations of COVID-19: A case report and a comprehensive review

Shah

Patel²,

Oza

et al. 2022

Preprint

View full text Add to dashboard Cite

show abstract

“…The incidence of thromboembolic events in COVID patients, causing life threatening conditions, might be higher than reported. 19 A study conducted in Italy revealed a direct increase in incidence of acute limb ischemia related to COVID, deduced from a significant increase in numbers during the pandemic months compared with the same time in the previous years. 20…”

Section: Discussionmentioning

confidence: 99%

Management of COVID-19-related Arterial Thrombosis Leading to Acute Limb-threatening Ischemia

Ehsan

Khan

Raza³

2021

Preprint

View full text Add to dashboard Cite

Objective: Examine the occurrence and clinical outcomes of arterial thrombosis leading to limb- threatening ischemia in patients with coronavirus-2019 (COVID-19). Study design: Prospective, descriptive case series. Patients and Methods: Forty-four patients with COVID-19 infection presenting with critical limb ischemia were managed between March 2020 and December 2020. The patients were divided into three groups based on the mode of presentation: 1) those who had been admitted; 2) those presenting in the emergency department; and 3) those presenting to vascular clinics. Clinical evidence suggesting limb ischemia was evaluated with computerized tomographic angiogram. Vascular care was designed according to the need of individual patients, through anticoagulation, revascularization by thrombo-embolectomy, or bypass grafting and amputation. Results: Ten major amputations and 4 deaths (all in patients admitted) occurred among the 44 patients (9.1%). Most patients (32/44) were males, mean age was 55, and limb ischemia occurred among patients as young as 29. The initial period of ischemia was often not appreciated by patients and physicians. Critical limb ischemia was often not correlated with the severity of COVD symptoms: of 17 patients who presented through the emergency room with limb-threatening ischemia, 10 (58.9%) were asymptomatic for respiratory and general symptoms. Comorbidities were common among all 3 patient groups (26/44; 59%). Anticoagulants did not consistently prevent thromboembolic events since all admitted patients were receiving low molecular weight heparin. The rate of revascularization was lower in this population than in the general population with similar limb ischemia. Conclusion: Acute limb ischemia in patients with COVID-19 is a vascular emergency that can result in limb loss and even death. The severity of respiratory infection and other symptoms of COVID often are not consistent with the severity and level of vascular involvement. Timely recognition and tailored intervention is needed to save limbs in this population.

show abstract

“…Macro- and micro-vascular thrombotic complications are also a growing source of morbidity and death in COVID-19 patients. The interaction between inflammation and the coagulation system probably contributes to their development [ 27 ]. In our case, the patient developed left superficial femoral vein thrombosis during the hospital stay.…”

Section: Discussionmentioning

confidence: 99%

Atypical Immunologic Manifestations of COVID-19: a Case Report and Narrative Review

Shah

Patel²,

Oza

et al. 2023

SN Compr. Clin. Med.

View full text Add to dashboard Cite

COVID-19 usually presents with classic signs and symptoms, but it can involve multiple systems in atypical cases. SARS-CoV-2 has a complex interaction with the host immune system leading to atypical manifestations. In our case, a 32-year-old male patient presented with fatigue, sores on hands and feet, headache, productive cough with blood-tinged mucus, conjunctival hyperemia, purpuric rash on hands and feet, and splinter hemorrhages of fingernails for 2 weeks. The patient’s SARS-CoV-2 antigen and PCR test were positive. Chest X-ray showed mixed density perihilar opacities in both lungs. Computed tomography of the chest showed extensive airspace opacities in both lungs, suggesting COVID-19 multifocal, multilobar pneumonitis. A renal biopsy indicated limited thrombotic microangiopathy and tubulointerstitial nephritis, for which he was started on steroids, and his renal functions gradually improved. He tested positive for C-ANCA during an immune workup. He was discharged with a steroid taper for nephritis. Once the taper reached less than 10 mg/day, he developed acute scleritis and a new pulmonary cavitary lesion of 6 cm. The biopsy via bronchoscopy revealed acute inflammatory cells with hemosiderin-laden macrophages. He was restarted on systemic steroids for scleritis after failing topical steroids, which incidentally also reduced the size of the cavitary lesion, indicating an immune component. Our case demonstrates the involvement of kidneys and vasculitis of the skin, sclera, and lungs by COVID-19. The patient’s symptoms were not explained by any diseases other than COVID-19. Atypical cases of COVID-19 disease with multifocal systemic symptoms involving the skin, sclera, lungs, and kidneys should be high on differentials. Early recognition and intervention may decrease hospital stays and morbidity.

show abstract

Life and Limb: a Case of COVID-19-Associated Multisystem Thrombosis and Review of the Literature

Cited by 4 publications

References 34 publications

Atypical immunologic manifestations of COVID-19: A case report and a comprehensive review

Atypical immunologic manifestations of COVID-19: A case report and a comprehensive review

Management of COVID-19-related Arterial Thrombosis Leading to Acute Limb-threatening Ischemia

Atypical Immunologic Manifestations of COVID-19: a Case Report and Narrative Review

Contact Info

Product

Resources

About