Splenic infarct in a COVID-19 patient under anticoagulant therapy with normal D-dimer levels.

Abstract

BACKGROUND:

Many studies have shown that COVID-19 can progress with coagulopathy and multisystemic thrombotic events. We report a patient who presented with abdominal pain after COVID-19 and was found to have splenic infarction (SI) concomitant with acute myocardial infarctus (MI) under anticoagulant treatment.

CASE PRESENTATION:

A 45-year-old man was admitted to the emergency department with left-sided abdominal pain radiating through to his back persisting for one day. He had COVID-19 PCR positivity nine days ago. After seven days of hospitalization due to COVID-19 pneumonia, he had been discharged with low-molecular-weight heparin (LMWH). Abdominal computerized tomography (CT) showed SI. His ECG and laboratory parameters were normal except for 17.2 × 10∧3/μL leukocytosis. The anticoagulant drug dose that he was taking was increased to 2 × 0.6 mL during hospitalization. He described new-onset chest pain during follow-up. Acute anterior MI was detected on ECG. Successful percutaneous coronary angiography was performed by cardiologists. No problems were observed in the follow-up. The patient was discharged on the fifth day of conservative treatment due to splenic infarction.

CONCLUSION:

Thrombosis prophylaxis with prophylactic doses of LMWH in hospitalized COVID-19 patients may not be sufficient to prevent the development of coagulopathy in patients. Abdominal-visceral thromboembolism should be suspected in a COVID-19-positive patient presenting with abdominal pain despite receiving anticoagulant therapy and normal d-dimer levels.

• Authors: Semra Demirli Atıcı, Göksever Akpınar
• Journal: International journal of surgery case reports (Int J Surg Case Rep) Vol. 92 Pg. 106847 (Mar 2022) ISSN: 2210-2612 [Print] Netherlands
• PMID: 35194547 (Publication Type: Case Reports)
• Copyright: © 2022 Published by Elsevier Ltd on behalf of IJS Publishing Group Ltd.