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1.
Neurologist ; 27(3): 143-146, 2022 May 01.
Article in English | MEDLINE | ID: covidwho-1831535

ABSTRACT

INTRODUCTION: Thrombotic events are potentially devastating complications of coronavirus disease 2019 (COVID-19) infection. Although less common than venous thromboembolism, arterial thrombosis has been reported in COVID-19 cohorts in almost 3% of patients. We describe a patient with COVID-19 infection and concurrent cerebral and noncerebral infarction. CASE REPORT: A 53-year-old man with history of COVID-19 pneumonia was admitted to a primary stroke center for speech disturbances and left hemiplegia. Urgent laboratory tests showed a great increase of inflammatory and coagulation parameters as D-dimer, ferritin, interleukin-6 and C-reactive protein. Neuroimaging found occlusion of the M1 segment of the right middle cerebral artery with early signs of ischemic stroke. He received intravenous thrombolysis and mechanical thrombectomy. Abdominal computed tomography discovered a splenic infarction with hemorrhagic transformation and bilateral renal infarction. Urgent angiography showed an associated splenic pseudoaneurysm, which was embolized without complications. He was treated with intermediate-dose anticoagulation (1 mg subcutaneous enoxaparin/kg/24 h), acetylsalicylic acid 100 mg and 5 days of intravenous corticosteroids. In the following days, inflammatory markers decreased so anticoagulant treatment was stopped and acetylsalicylic acid 300 mg was prescribed. His condition improved and he was discharged to a rehabilitation facility on hospital day 30. CONCLUSION: In this case, a patient with multiple thrombotic events in the acute phase of COVID-19 infection, the delimitation of the inflammatory state through analytical markers as D-dimer helped to individualize the antithrombotic treatment (full anticoagulation or anticoagulation at intermediate doses plus antiplatelet treatment as used in our patient) and its duration. However, more data are needed to better understand the mechanisms and treatment of stroke in patients with COVID-19 infection.


Subject(s)
COVID-19 , Stroke , Thrombosis , Anticoagulants , Aspirin , COVID-19/complications , Humans , Infarction/complications , Infarction/diagnostic imaging , Male , Middle Aged , Stroke/complications , Thrombosis/drug therapy
3.
Saudi J Kidney Dis Transpl ; 32(3): 865-868, 2021.
Article in English | MEDLINE | ID: covidwho-1662745

ABSTRACT

After its discovery in Wuhan, China, in December 2019, coronavirus disease 2019 (COVID-19) has now become a pandemic in a short period. The kidney involvement is frequently reported, especially in critically ill hospitalized patients. Multiple mechanisms have been proposed for this damage range from direct invasion, cytokine storm, and hemodynamic derangements. Although COVID-19 has been described to have association with hypercoagulable state and thromboembolic events in major blood vessels, renal infarction due to COVID-19 infection is a rare occurrence. We here report a rare case of renal infarction due to COVID-19 infection. This patient initially presented with COVID pneumonia with acute kidney injury. Later on during evaluation of his gastrointestinal complaints, he was detected to have renal infarction by computed tomography angiography.


Subject(s)
Acute Kidney Injury/etiology , COVID-19/complications , Infarction/diagnostic imaging , Infarction/etiology , COVID-19 Nucleic Acid Testing , Computed Tomography Angiography , Critical Illness , Humans , Kidney/diagnostic imaging , Male , Middle Aged , Reverse Transcriptase Polymerase Chain Reaction , SARS-CoV-2
4.
J Infect Chemother ; 28(2): 326-328, 2022 Feb.
Article in English | MEDLINE | ID: covidwho-1517342

ABSTRACT

COVID-19 is an infection which can present with various clinical manifestations. While it affects respiratory tract primarily, several other manifestations including gastrointestinal involvements have been reported. The prevalence of all gastrointestinal complaints is approximately 17 percent and diarrhea, nausea/vomiting and abdominal pain are the most common symptoms. In COVID-19, acute abdominal pain requiring surgical evaluation and abdominal imaging is uncommon and there is also a lack of knowledge about COVID-19 related gastrointestinal complications. Here, we report a case of mild COVID-19 infection complicated by omental infarction during the course of the illness.


Subject(s)
COVID-19 , Gastrointestinal Diseases , Humans , Infarction/diagnostic imaging , Infarction/etiology , SARS-CoV-2 , Vomiting
7.
J Clin Neurosci ; 87: 89-91, 2021 May.
Article in English | MEDLINE | ID: covidwho-1120247

ABSTRACT

Coronavirus disease (COVID-19) has a number of emerging neurological manifestations in addition to pneumonia and respiratory distress. In what follows, we describe a case of a previously healthy young man with severe COVID-19 who subsequently developed an acute flaccid paralysis. Work up revealed a lesion in his cervical spinal cord concerning for spinal infarction or transverse myelitis. He received empiric pulsed steroids without improvement. Taken together, we felt his presentation was most consistent with spinal cord infarction in the setting of critical illness with COVID-19. We believe this is a rare case of spinal cord stroke associated with COVID-19.


Subject(s)
COVID-19/complications , COVID-19/diagnostic imaging , Cervical Cord/diagnostic imaging , Infarction/diagnostic imaging , Infarction/etiology , Adult , Humans , Male , Spinal Cord Ischemia/diagnostic imaging , Spinal Cord Ischemia/etiology
9.
Infez Med ; 28(4): 611-615, 2020 Dec 01.
Article in English | MEDLINE | ID: covidwho-950503

ABSTRACT

The prothrombotic state contributes to diverse and devastating prognoses of severe COVID-19. We describe a unique COVID-19 case with concomitant splenic and renal infarcts. Based on this, clinicians should have a low threshold to suspect a diagnosis of deep vein thrombosis/pulmonary embolism (DVT/PE), especially in the abdominal visceral region if a patient comes in several days after a COVID-19 diagnosis with abdominal pain. Whether or not empiric full dose anticoagulation is needed in patients without definite diagnosis of thromboembolism is still controversial. Further studies need to be done; meanwhile, we advocate the use of regular dose thromboprophylaxis in all hospitalized patients and therapeutic anticoagulation only when there is a confirmed diagnosis of thromboembolism.


Subject(s)
COVID-19/complications , Infarction/etiology , Kidney/blood supply , SARS-CoV-2 , Splenic Infarction/etiology , COVID-19/diagnostic imaging , Humans , Infarction/diagnostic imaging , Kidney/diagnostic imaging , Male , Middle Aged , Splenic Infarction/diagnostic imaging
10.
Am J Kidney Dis ; 76(3): 431-435, 2020 09.
Article in English | MEDLINE | ID: covidwho-436397

ABSTRACT

Coronavirus disease 2019 (COVID-19) is a contagious life-threatening infection caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Recent findings indicate an increased risk for acute kidney injury during COVID-19 infection. The pathophysiologic mechanisms leading to acute kidney injury in COVID-19 infection are unclear but may include direct cytopathic effects of the virus on kidney tubular and endothelial cells, indirect damage caused by virus-induced cytokine release, and kidney hypoperfusion due to a restrictive fluid strategy. In this report of 2 cases, we propose an additional pathophysiologic mechanism. We describe 2 cases in which patients with COVID-19 infection developed a decrease in kidney function due to kidney infarction. These patients did not have atrial fibrillation. One of these patients was treated with therapeutic doses of low-molecular-weight heparin, after which no further deterioration in kidney function was observed. Our findings implicate that the differential diagnosis of acute kidney injury in COVID-19-infected patients should include kidney infarction, which may have important preventive and therapeutic implications.


Subject(s)
Acute Kidney Injury/diagnostic imaging , Betacoronavirus , Coronavirus Infections/diagnostic imaging , Infarction/diagnostic imaging , Kidney/blood supply , Kidney/diagnostic imaging , Pneumonia, Viral/diagnostic imaging , Acute Kidney Injury/drug therapy , Acute Kidney Injury/etiology , COVID-19 , Coronavirus Infections/complications , Coronavirus Infections/drug therapy , Diagnosis, Differential , Heparin, Low-Molecular-Weight/pharmacology , Heparin, Low-Molecular-Weight/therapeutic use , Humans , Infarction/drug therapy , Infarction/etiology , Male , Middle Aged , Pandemics , Pneumonia, Viral/complications , Pneumonia, Viral/drug therapy , SARS-CoV-2
11.
Emerg Infect Dis ; 26(8): 1926-1928, 2020 Aug.
Article in English | MEDLINE | ID: covidwho-245715
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