Spontaneous iliopsoas hematoma: A warning for CoViD-19

ABSTRACT

Background: Patients with CoViD-19 are at high risk of thromboembolic events due to hemostatic changes directly related to the SARS-CoV-2 infection or to the consequence of cytokine storm. Anticoagulation with heparin is recommended to reduce the thrombotic risk. Spontaneous iliopsoas hematoma (IPH) is a potentially life-threatening complication of anticoagulation therapy described in CoViD-19 patients. Materials and Methods: We report two cases of association with IPH and SARS-CoV-2 pneumonia treated with heparin. Results: Over a 5-month period (November 2020-April 2021) 252 subjects with SARS-CoV-2 infection were admitted to our CoViD hospital. We found two cases of spontaneous IPH during the clinical course of CoViD-19. Diagnosis of IPH was made by CT angiogram. Coagulation parameters and platlet count were normal. One patient (an 83-year-old woman) was on prophylactic low weight molecular heparin (LWMH). The other patient (a 79-yearold man) received a therapeutic dosage with LWMH for pulmonary thrombosis and died, after urgent transarterial embolization, because of hemorrhagic hypovolemic shock. Conclusions: Although case reports are scarce for conclusion, our two cases, in addition to previous reports, suggest that CoViD-19 patients treated with anticoagulants are at risk of IPH. Given the indications to prescribe anticoagulation in CoViD-19 and the lack of solid evidences on the optimal dose and duration, it is important to be aware of IPH as a potentially serious complication. Rapid diagnosis and timely intervention are crucial to ensure good patient outcomes.