Pulmonary Embolism and Acute Psychosis, a Case Report of an Outpatient with a Mild Course of COVID-19

Abstract

The increased risk for thromboembolism in hospitalized COVID-19 patients has been communicated extensively. The fact that home quarantined patients can develop pulmonary embolism, however, has so far not been reported. Furthermore, attention should be brought to psychotic developments in COVID-19 patients. We report a 46-year-old previously healthy patient with a mild course of COVID-19, who developed a massive pulmonary embolism with right heart strain while being home quarantined. He was hospitalized and anticoagulant therapy was started. Nine days after admission, the patient appeared increasingly psychotic and suffered from hallucinations as well as paranoid thoughts. After treatment with risperidone and valproate, the patient’s condition improved. At a follow-up 1 month after discharge, he was completely recovered regarding the respiratory, cardiac, and psychic situation. SARS-CoV-2 infection can not only increase the prevalence of thromboembolism in hospitalized patients but also in outpatients. COVID-19 also increases the risk of developing psychiatric reactions.

COVID-19-associated psychosis: A systematic review of case reports

“…Finally, 18 articles did not include individual level data and 7 articles were available as abstracts only. A total of 40 articles met inclusion criteria, comprising 48 individual patients from 17 countries ( Table 1 ) [ [25] , [26] , [27] , [28] , [29] , [30] , [31] , [32] , [33] , [34] , [35] , [36] , [37] , [38] , [39] , [40] , [41] , [42] , [43] , [44] , [45] , [46] , [47] , [48] , [49] , [50] , [51] , [52] , [53] , [54] , [55] , [56] , [57] , [58] , [59] , [60] , [61] , [62] , [63] , [64] ]. All but a single study [ 54 ] were in English and 20 (42%) cases were reported in the United States, where the largest proportion of these cases were documented.…”

“… Reported Dx: Psychotic disorder due to another medical condition DSM-5 Dx: Psychotic disorder due to COVID-19, with hallucinations Recent episode of delirium No CSF studies. Makivic, 2021 [ 51 ] 46, M, AT On day 21 of symptoms, patient developed hallucinations and discharged on risperidone, then readmitted a few hours later with suspected psychogenic seizures. Cough hemoptysis, headache, dysgeusia, vomiting and diarrhea on home quarantine.…”

COVID-19-Associated Acute Psychotic Disorder—Longitudinal Case Report and Brief Review of Literature

“…Since the early stage of the pandemic, cases describing patients with COVID-19-induced psychosis were increasingly reported in the literature with the aim to highlight one of the numerous possible complications of this rapidly emerging infectious disease. Concerning psychopathological features, numerous cases presented female or male individuals with different types of delusions (i.e., persecutory, grandeur, reference, death, and religious) and auditory hallucinations [ 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 ] as the main part of clinical presentation. Of note, similar to our case, the symptomatology reported in some patients included visual or tactile hallucinations as well [ 28 , 31 , 32 , 33 ], which are a common characteristic of psychosis due to organic aetiology [ 42 ].…”

“…Concerning psychopathological features, numerous cases presented female or male individuals with different types of delusions (i.e., persecutory, grandeur, reference, death, and religious) and auditory hallucinations [ 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 ] as the main part of clinical presentation. Of note, similar to our case, the symptomatology reported in some patients included visual or tactile hallucinations as well [ 28 , 31 , 32 , 33 ], which are a common characteristic of psychosis due to organic aetiology [ 42 ]. These particular COVID-19 associated symptoms could be explained by the hypothesis of SARS-CoV-2-induced brain injury, which is thought to be determined through direct neuronal invasion and systemic massive inflammation [ 20 , 43 ].…”

Pathophysiological Hypothesis of COVID-19 Psychosis

“…Kozato et al (2021) reported the case of a 50-year-old man, with no personal or family psychiatric history, who presented a picture consisting of panic attacks, insomnia, and auditory, visual, and tactile hallucinations 2 weeks after being diagnosed with COVID-19; this patient had received corticosteroid treatment for complications of his viral infection. Makivic et al (2021) reported on a 46-year-old man with a history of SARS-CoV-2 pulmonary thromboembolism who experienced visual and auditory delusions and hallucinations, in addition to bizarre behaviors such as taking disinfectant 3 weeks after being infected with the virus. Mirza et al (2020) reported the case of a 53-year-old man with no psychiatric history, who was admitted after an apparent suicide attempt: this behavior was strange to his wife.…”