Published online Sep 18, 2020. doi: 10.5495/wjcid.v10.i3.42
Peer-review started: July 9, 2020
First decision: July 21, 2020
Revised: August 2, 2020
Accepted: September 1, 2020
Article in press: September 1, 2020
Published online: September 18, 2020
The hypercoagulable state associated with coronavirus disease 2019 (COVID-19) has been shown to complicate the course of this viral illness with both venous and arterial clots. Often presenting after hospitalization and known COVID-19 diagnosis, the etiology of thrombosis has been attributed to the hyperinflammatory state and endothelial dysfunction associated with COVID-19. This report portrays a patient who experienced an aortic thrombosis resulting in back and leg pain with subsequent loss of motor function of his legs as his initial presentation of COVID-19.
Patient is a 60-year-old Caucasian male with no medical history who presented with sudden onset pain in his lower back and lower extremities. He went on to experience complete motor loss of the lower extremities two hours after admission. Chest pain and shortness of breath developed one day later but were not present at time of presentation. Computed tomography angiography of the chest, abdomen, and pelvis revealed occlusion by thrombosis of the abdominal aorta in addition to multifocal pulmonary ground-glass opacities prompting COVID-19 PCR, which was positive. He was taken to surgery for attempted thrombectomy and the thrombus was retrieved starting from the right common femoral artery, but a second thrombus had immediately reformed in place of the prior thrombectomy site resulting in conclusion of the procedure. He was continued on unfractionated heparin and received a dose of tocilizumab 400 mg, but rapidly developed hemodynamic compromise and expired from cardiac arrest.
This presentation emphasizes the importance of evaluating patients for COVID-19 who experience unusual thromboses without superior explanation.
Core Tip: Aortic thrombosis preceding respiratory symptoms should raise suspicion for testing for coronavirus disease 2019 in patients with unusual thrombosis presentation.