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INTRODUCTION: This case report discussed and reviewed an atypical presentation of COVID 19 involving superior mesenteric artery thrombosis with associated ischemic colitis. Thrombosis had been reported in up to 50 percent of patients with severe COVID -19. The pathophysiology of thrombosis in COVID 19 infection may include increasing blood viscosity and endothelial damage. DESCRIPTION: Case: A 59-year-old male with GERD, hiatal hernia, and diverticulitis was presented with ten days history of abdominal pain and vomiting, which later became coffee ground in nature. He was diagnosed with COVID 19 seven days before his presentation. Lab work showed hypokalemia with lactic acidosis, polycythemia, leukocytosis, thrombocytosis, and elevated D dimer. Esophagogastroduodenoscopy demonstrated actively bleeding Mallory Weiss tear successfully treated with bipolar circumactive probe cautery (BICAP). The patient's abdominal pain worsened, and a repeat CTA abdomen revealed a superior mesenteric artery thrombosis with thickening of the distal small bowel and ascending colon. Vascular surgery was consulted, and performed catheter-assisted tPA thrombolysis to the SMA. Atrial fibrillation, diverticulitis, and other possible causes were eliminated as etiologies. DISCUSSION: Acute mesenteric ischemia is a rare abdominal emergency. Due to rapid deterioration, early diagnosis and treatment are momentous for management. Severe abdominal pain and hematemesis are the keys to starting the evaluation. Initial investigation should include basic labs with a coagulation profile;the most common abnormalities are polycythemia, metabolic acidosis, lactic acidosis, and leukocytosis. CTA provides exquisite detail of the vascular anatomy and beneficial information regarding other bowel pathologies. After diagnosis, definitive management with fluid resuscitation, antibiotics, and IV high dose unfractionated heparin, if not contraindicated, should be initiated immediately. Recently, catheter-directed procedures for intravascular thrombectomy have been used with tPA. CONCLUSION(S): In our case, we attempted to emphasize the importance of a high index of suspicion with proper history, physical examination, and appropriate imaging for proper diagnosis and management of this life-threatening incident.
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TOPIC: Transplantation TYPE: Fellow Case Reports INTRODUCTION: SARS-CoV2, commonly known as COVID-19, has been noted to manifest severe illness in certain patient populations. The clinical manifestations of this coronavirus in solid organ transplant recipients is just beginning to be described, and is not well understood. SARS-CoV2 and associated illness have been described in multiple patient populations, so far limited data has been published on the course of illness in lung transplant recipients. Here we present a case series of 26 patients who were unfortunately infected with SARS-CoV2. CASE PRESENTATION: We conducted a single-center, retrospective review of 26 lung transplant recipients infected with SARS-CoV2. Data collection and patient consent were covered by OSU IRB protocol. DISCUSSION: 15 of these patients (55.5%) required admission for hypoxemia, and 4 required intubation and mechanical ventilation. 1 patient required extracorporeal membrane oxygenation (ECMO). 46% (12/26) patients received dexamethasone and remdesivir, 27% (7/26) received convalescent plasma, 1 received hydroxychloroquine, and 2 received azithromycin as part of their treatments. Prior to COVID-19 infection all patients but 1 were on a standard triple immune suppression regimen with calcineurin inhibitors, steroids, and cell cycle inhibitors. Calcineurin dosing was decreased in 2 patients with severe COVID-19 and cell cycle inhibitors were reduced by 50% or held for 2 weeks 50% patients. 1 patient succumbed to COVID-19 ARDS despite ECLS support and a second 3 months after initial diagnosis due to a massive CVA. Mortality 3 months after initial diagnosis was 7.6% which is lower than other reported series. The average change in FEV1 was a loss of 0.52 liters. An average loss of 0.69 liters of FVC was noted in survivors. CONCLUSIONS: To our knowledge this is one of the largest currently reported case series of lung transplant recipients with SARS-CoV2. Overall, mortality was higher in this group than in the general population but at 7.6% 3 months after diagnosis is lowest of the single center reports published. As expected, a decrease in lung function was noted in survivors. Three was no general difference in lung function in patients who received certain treatments over others. REFERENCE #1: Tsuang WM, Budev MM. COVID-19 and lung transplant patients. Cleve Clin J Med. 2020. REFERENCE #2: Aigner C, Dittmer U, Kamler M, Collaud S, Taube C. COVID-19 in a lung transplant recipient. J Heart Lung Transplant. 2020;39(6):610-611. REFERENCE #3: Keller BC, Le A, Sobhanie M, et al. Early COVID-19 infection after lung transplantation. Am J Transplant. 2020;20(10):2923-2927. DISCLOSURES: No relevant relationships by Mena Botros, source=Web Response No relevant relationships by Molly Howsare, source=Web Response