Splenic infarction and pulmonary embolism as a rare manifestation of COVID-19

Abstract

Coronavirus disease 2019 (COVID-19) disease leads to a hypercoagulable state and associated with thrombotic events that can cause mortality and morbidity. Thrombotic events include both venous and arterial thrombosis. In this case report, we present a 68-year-old COVID-19 patient with multisystemic infarction who was admitted to the hospital by splenic infarction and later pulmonary embolism diagnosed during the stay in hospital despite anticoagulant use. It is important for emergency physicians to know that patients who had COVID-19 infection but not confirmed or not tested can visit the emergency department due to complications of COVID-19 infection such as thromboembolic events primarily.

Splenic Artery Infarct Requiring Surgery: A Rare Complication of COVID-19 Infection

“…We also conducted a literature search across the Medline, PubMed, and Google Scholar databases regarding splenic artery infarct or occlusion in COVID-19 patients and found that such an infarct due to thrombosis appears seldom, with only 45 cases reported so far. Of these cases, 30 were male patients and 12 were female, while the patient's gender was not mentioned for three cases ( Table 2 ) [ 2 – 14 , 16 , 19 – 32 , 34 – 44 ].…”

“…Moreover, an increase in D-dimer levels is not sufficient to diagnose arterial or venous thrombosis owing to the considerable inflammatory reaction and significant rise in D-dimer levels following COVID-19 infection [ 2 , 16 ]. Nevertheless, the chances of hypercoagulability that accompanies this disease should raise suspicion of thrombotic events in unusual sites, and treatment with anticoagulants should start immediately after diagnosis [ 14 , 24 ]. A combination of more than two agents is sometimes necessary, and prolonged treatment, even after improvement, is, at times, inevitable [ 45 ].…”

“…Furthermore, from a brief review of the literature, we observed that antithrombotic treatment with LMWH, ASA, and other anticoagulants results in improvement in splenic artery infarcts, causes recanalization of the splenic artery, and that splenectomy is required only in the case of clinical deterioration of the patient [ 20 , 30 , 31 , 33 , 41 , 47 ]. While we await further data from clinical trials regarding treatment guidelines, a reasonable approach would be to continue with regular-dose thromboprophylaxis in all COVID-19 patients and to provide therapeutic anticoagulation in patients with confirmed thrombotic events [ 2 , 14 , 21 , 24 , 35 , 39 ].…”

“…On the other hand, arterial thrombotic events are less commonly described [ 6 , 9 , 10 ]. Arterial thromboembolism encompasses a variety of conditions, including myocardial infarction, stroke, and visceral infarcts, such as renal, splenic, and intestinal infarcts [ 2 , 13 , 14 ]. Despite their rarity, abdominal visceral infarcts are increasingly being detected and documented as the disease is spreading.…”

Clinical, Hematological, Biochemical and Radiological Characteristics for Patients With Splenic Infarction: Case Series With Literature Review

“…Infection Cytomegalovirus [6][7][8] Epstein-Barr virus [9][10][11][12][13][14][15] Infective endocarditis [16][17][18][19][20][21][22] COVID-19 [23][24][25][26][27][28][29][30][31][32][33][34][35] Dengue virus [36] Mycoplasma pneumoniae [37,38] Malaria [39,40] Scrub typhus [41,42] Aspergillus pericarditis [43] Babesiosis [44] Malignancy including neoplasm and myeloproliferative diseases…”