tetano
Editor, Senior Moderator
J Thromb Thrombolysis
. 2020 Jun 6.
doi: 10.1007/s11239-020-02173-w. Online ahead of print.
Hyperacute Multi-Organ Thromboembolic Storm in COVID-19: A Case Report
Sarah Chibane[SUP] 1 [/SUP], Guillaume Gibeau[SUP] 2 [/SUP], Fr?d?ric Poulin[SUP] 2 [/SUP], Pierre Tessier[SUP] 2 [/SUP], Michelle Goulet[SUP] 2 [/SUP], Marc Carrier[SUP] 3 [/SUP], Sylvain Lanthier[SUP] 4 [/SUP]
Affiliations
Abstract
Acute viral pneumonia, hypoxemic respiratory failure and severe inflammatory response are hallmarks of severe coronavirus disease 2019 (COVID-19). The COVID-19-associated inflammatory state may further lead to symptomatic thromboembolic complications despite prophylaxis. We report a 66-year-old female patient with post-mortem diagnosis of COVID-19 who presented progressive livedo racemosa, acute renal failure and myocardial injury, as well as an absence of respiratory symptoms. Transthoracic echocardiography showed severe spontaneous echo contrast in the right cardiac chambers and right-sided cardiac overload presumed to result from pulmonary microvascular thrombosis or embolism. D-dimer levels were increased. The patient developed an acute ischemic stroke and died 2 days following presentation despite therapeutic anticoagulation. Her predominantly thromboembolic presentation supports the concept of coronavirus infection of endothelial cells and hypercoagulability, or COVID-19 endotheliitis. The case we report highlights that COVID-19-associated hyperacute multi-organ thromboembolic storm may precede or present disproportionately to respiratory involvement.
Keywords: COVID-19; Spontaneous echo contrast; Thromboembolism.
. 2020 Jun 6.
doi: 10.1007/s11239-020-02173-w. Online ahead of print.
Hyperacute Multi-Organ Thromboembolic Storm in COVID-19: A Case Report
Sarah Chibane[SUP] 1 [/SUP], Guillaume Gibeau[SUP] 2 [/SUP], Fr?d?ric Poulin[SUP] 2 [/SUP], Pierre Tessier[SUP] 2 [/SUP], Michelle Goulet[SUP] 2 [/SUP], Marc Carrier[SUP] 3 [/SUP], Sylvain Lanthier[SUP] 4 [/SUP]
Affiliations
- PMID: 32506364
- DOI: 10.1007/s11239-020-02173-w
Abstract
Acute viral pneumonia, hypoxemic respiratory failure and severe inflammatory response are hallmarks of severe coronavirus disease 2019 (COVID-19). The COVID-19-associated inflammatory state may further lead to symptomatic thromboembolic complications despite prophylaxis. We report a 66-year-old female patient with post-mortem diagnosis of COVID-19 who presented progressive livedo racemosa, acute renal failure and myocardial injury, as well as an absence of respiratory symptoms. Transthoracic echocardiography showed severe spontaneous echo contrast in the right cardiac chambers and right-sided cardiac overload presumed to result from pulmonary microvascular thrombosis or embolism. D-dimer levels were increased. The patient developed an acute ischemic stroke and died 2 days following presentation despite therapeutic anticoagulation. Her predominantly thromboembolic presentation supports the concept of coronavirus infection of endothelial cells and hypercoagulability, or COVID-19 endotheliitis. The case we report highlights that COVID-19-associated hyperacute multi-organ thromboembolic storm may precede or present disproportionately to respiratory involvement.
Keywords: COVID-19; Spontaneous echo contrast; Thromboembolism.