ABSTRACT
Context: Hypercoagulability is a known phenomenon during acute COVID-19 infection. Studies have demonstrated higher levels of d-dimer, fibrinogen, and fibrinogen degradation products. Also evidence of vascular endothelial damage associated with this infection. Finding(s): 59 y/o man with new C5 complete tetraplegia admitted to rehab 9 months after acute SARs CoV-2 pneumonia. He required hospitalization, but recovered after a couple of weeks, ultimately returning to work. However, 6 months later he started having episodes of dizziness. He presented emergently 7 months later with severe dyspnea and chest tightness. He was diagnosed with a massive saddle pneumonia embolism, source: left femoral, popliteal, and tibial deep venous thrombosis. Treatment included tissue plasminogen activator (TPA) intervention and 2 days later experienced acute onset of lower extremity weakness. Imaging revealed a C2-T11 epidural hematoma with cord compression. Conclusion/Clinical Relevance: Post covid-19 disease syndrome(s), such as long haulers, have prolonged symptoms for months. Therefore, Covid-19 disease could be associated with a prolonged hypercoagulable state in some cases. Research data reporting the rates of thrombosis after acute infection are limited. This case stands out because the patient had no risk factors for VTE besides his age. He was a thin, nonsmoker, not acutely ill, active, working fulltime in a non-sedentary occupation, and had no previous personal nor family history for VTE. In regard to post rehab disposition the patient's wife was identified as the anticipated caregiver, however she never fully recovered and the patient was discharged to a skilled nursing facility.