ABSTRACT
BACKGROUND In corona virus disease 2019 (COVID-19), which emerged in December 2019 and is caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), most case presentations have been related to the respiratory tract. Several recent studies reveal that angiotensin-converting enzyme 2 (ACE2), which was found in the target cells of the virus, is highly expressed in the lungs, small bowel, and vasculature. CASE REPORT A 29-year-old male construction worker from India presented with left-sided colicky abdominal pain. He tested positive for infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) by reverse transcription-polymerase chain reaction (RT-PCR). Isolated superior mesenteric vein thrombosis was diagnosed by CT (computed tomography) scan. He was managed by anti-coagulants and clinically improved. CONCLUSIONS This case report indicates that isolated venous thrombosis of the abdominal vessels without concurrent arterial thrombosis can be a complication of the hyper-coagulability state in COVID-19 patients. Hence, early evaluation of abdominal vessels in covid-19 patients who present with any abdominal symptoms should be considered, especially when found to have an elevated D-dimer level, as early treatment of thrombosis with low-molecular-weight heparin can have a significant impact on the therapeutic outcome.
Subject(s)
Anticoagulants/administration & dosage , Coronavirus Infections/complications , Mesenteric Vascular Occlusion/diagnostic imaging , Pneumonia, Viral/complications , Venous Thrombosis/diagnostic imaging , Venous Thrombosis/drug therapy , Abdominal Pain/diagnosis , Abdominal Pain/etiology , Adult , COVID-19 , COVID-19 Testing , Clinical Laboratory Techniques/methods , Construction Industry , Coronavirus Infections/diagnosis , Humans , India , Male , Mesenteric Vascular Occlusion/drug therapy , Mesenteric Vascular Occlusion/virology , Mesenteric Veins , Pandemics , Pneumonia, Viral/diagnosis , Radiography, Thoracic/methods , Real-Time Polymerase Chain Reaction/methods , Risk Assessment , Severity of Illness Index , Tomography, X-Ray Computed/methods , Treatment Outcome , Venous Thrombosis/complicationsABSTRACT
Hematomyelia is rare, and usually related to major trauma. Non-traumatic causes are much rarer and include underlying vascular malformations and cord tumors. We present the case of a previously well 44-year-old woman who developed severe acute neck pain and right-sided motor deficit after a session of traditional Chinese massage that entailed minimal neck manipulation. Emergent MRI confirmed hematomyelia of the right cervical hemicord, notably without associated bony or ligamentous injury. Follow-up spinal angiography and MRIs revealed no underlying vascular malformation or tumor. We highlight this case as there has been no reported case of hematomyelia occurring after mild trauma, although two cases of idiopathic hematomyelia have been reported. Though exceedingly rare, hematomyelia should be considered in the list of differential diagnoses in any case of neck pain and motor deficit after seemingly trivial injury.
