Spontaneous Muscle Hematoma in Japanese Patients with Severe COVID-19 Treated with Unfractionated Heparin: Two Case Reports

Abstract

In hospitalized coronavirus disease 2019 (COVID-19) patients, anticoagulation therapy is administered to prevent thrombosis. However, anticoagulation sometimes causes bleeding complications. We herein report two Japanese cases of severe COVID-19 in which spontaneous muscle hematomas (SMH) developed under therapeutic anticoagulation with unfractionated heparin. Although the activated partial prothrombin time was within the optimal range, contrast-enhanced computed tomography (CECT) revealed SMH in the bilateral iliopsoas muscles in both cases, which required emergent transcatheter embolization. Close monitoring of the coagulation system and the early diagnosis of bleeding complications through CECT are needed in severe COVID-19 patients treated with anticoagulants.

What Do We Need to Know About Musculoskeletal Manifestations of COVID-19?

“…Twenty literature reviews were identified2, 12-30 . Of the remaining studies, 31 presented original research 31-61 , 6 were case series 62-67 , 24 were case reports 68-91 , 1 provided a specialist’s opinion 92 , 4 were editorials 93-96 , and 2 were letters to the editor 97,98 .…”

“…We also found case reports or case series of critical illness myopathy, onset of Emery-Dreifuss syndrome that had been latent, Elsberg syndrome, IgG (immunoglobulin G)-related autoimmune inflammatory necrotizing myositis, and spontaneous iliopsoas hematomas 67,68,74,81,84,85 . Additional identified manifestations were acute sarcopenia, Guillain-Barré syndrome, muscle denervation atrophy, and myositis 5,8,18,22,23,52,72,92,93 .…”