A case of COVID-19 with superficial thrombophlebitis caused by an indwelling peripheral venous catheter (preprint)

Background: COVID-19 is caused by SARS-CoV-2 infection, and cytokine storm and microthrombus formation affect the severity of the disease, which is often complicated by venous thrombosis due to a systemic hypercoagulable state. On the other hand, indwelling peripheral venous catheters can cause catheter-related bloodstream infections and venous thrombus formation, albeit less frequently. Case presentation: A 53-year-old man was admitted to the hospital with severe COVID-19. He had bilateral pneumonia and required ventilator management but recovered after steroid and anticoagulation. On the 26th day after onset, redness, swelling, and pain developed around the insertion site of the catheter placed in the cephalic vein of the left forearm. Vascular ultrasonography revealed a thrombus in this vein accompanied by inflammation in the surrounding tissues. Catheter-related bloodstream infection was suspected and vancomycin was administered; however, blood cultures were negative, leading to the diagnosis of non-infectious superficial thrombophlebitis. The skin findings improved after removal of the peripheral venous catheter. Conclusions: This case suggested that catheter placement in peripheral veins during COVID-19 treatment increases the risk of thrombus formation. Although anticoagulant therapy is able to control the systemic hypercoagulable state caused by COVID-19, indwelling catheters can induce a local hypercoagulable state, leading to superficial thrombophlebitis.

Therapeutic potential of mesenchymal stem/stromal cells-derived exosomes in acute respiratory distress syndrome and COVID-19 (preprint)

Coronavirus disease 2019 (COVID-19) caused by novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has reached a global epidemic across the world after first reported in Wuhan, China’s Hubei province in December 2019. The pandemic is also associated with acute respiratory distress syndrome (ARDS) characterized by excess inflammation, progressive arterial hypoxemia and dyspnea. Mesenchymal stem/ stromal cells (MSCs) have been investigated as treatment for ARDS due to immunomodulatory property. Exosomes derived from MSCs play an important role in paracrine signaling of MSCs, thereby contributed to immunomodulation of the immune microenvironment. Exosomes are emerged as potential alternative to MSC cell therapy with superiority of safety. In this review, we will introduce MSC-derived exosomes and briefly discuss current progress on MSCs and exosomes in ARDS, which may have clinical implications in pathogenesis and treatment of COVID-19.