Deep vein thrombosis with pulmonary thromboembolism in a case of severe COVID-19 pneumonia

Abstract

A 53-year-old man with diabetes came to the emergency department with fever and dry cough for 5 days, swelling of the left leg for 2 days, shortness of breath and chest pain for 1 hour. He had raised temperature, tachycardia, tachypnoea, reduced oxygen saturation and swollen tender left leg on examination. The frontal chest radiograph showed bilateral ground-glass opacities; he tested positive for COVID-19 with elevated D-dimer. The colour Doppler examination of the left leg revealed acute deep vein thrombosis (DVT) of the common femoral and the popliteal veins. The chest CT showed bilateral diffuse ground-glass opacities predominantly involving peripheral zones and the lower lobes. The CTPA revealed left pulmonary thromboembolism (PTE), treated with low-molecular-weight heparin. COVID-19 predominantly affects the respiratory system. DVT and PTE are common in COVID-19 but lethal. They should be diagnosed early by clinical and radiological examinations and treated promptly with anticoagulants.

Safety of COVID-19 Vaccines among Patients with Type 2 Diabetes Mellitus: Real-World Data Analysis

“…In general, patients with T2DM have higher blood viscosity than those without diabetes [19]. Likewise, patients with COV-ID-19 with comorbidities, such as diabetes, are more vulnerable to thrombotic events [16,20,21]. The release of pro-inflammatory cytokines [22,23], along with hypoxia, immobility, and disseminated vascular coagulation [20,[24][25][26][27], is intimately linked to the pathophysiology of thrombosis in patients with T2DM with COVID-19.…”

“…Likewise, patients with COV-ID-19 with comorbidities, such as diabetes, are more vulnerable to thrombotic events [16,20,21]. The release of pro-inflammatory cytokines [22,23], along with hypoxia, immobility, and disseminated vascular coagulation [20,[24][25][26][27], is intimately linked to the pathophysiology of thrombosis in patients with T2DM with COVID-19. Thromboembolism events among patients with COVID-19 have also shown decreased platelet production and elevated d-dimer levels that hinder blood clotting [28].…”

Trombose venosa profunda em pacientes com COVID-19:

“…Outro caso de um paciente com 48 anos também evidenciou sintomas semelhantes como dificuldade de sustentar o peso da perna, dor, eritema e edema e ao realizar a ultrassonografia duplex da perna direita demosntrou uma trombose venosa profunda parcialmente oclusiva nas veias femorais comum, poplítea e coagulo oclusivo agudo na veia gastrocnêmio 32 . Apesar da TVP poder ter uma apresentação assintomática outros casos também evidenciaram sintomas semelhantes como os relatados anteriormente [33][34] .…”