Concomitant renal and splenic infarctions in a COVID-19-patient with a catastrophic thrombotic syndrome.

Since the outbreak of the COVID-19 pandemic, thrombotic events have been accurately described in patients infected by the SARS-CoV-2, especially venous thromboembolism. However, the mystery of arterial thrombosis is still unclear. Here, we report the case of a 59-year-old man with diabetes mellitus, admitted for COVID-19-pneumonia complicated by pulmonary embolism, a thrombus in the aortic isthmus, the descending thoracic aorta associated with splenic and left renal infarctions, and an acute right limb ischemia. The etiological assessment of this catastrophic thrombotic syndrome showed no evidence for preexisting inherited or acquired thrombophilia. Our case emphasizes the hypercoagulability state in COVID-19-patient leading to both arterial and venous thromboembolisms and the need to establish adequate strategies for the diagnosis and management of thrombo-embolisms to prevent these potentially fatal complications.

COVID-19 complicated by infective endocarditis or concomitant infection? a case report.

Coronavirus disease 2019 (COVID-19) is a global pandemic and public health emergency. With a high infectivity and dissemination rate, cardiovascular complications have been observed and associated with a poorer prognosis. COVID-19 appears to be both a risk and prognosis factor for infective endocarditis. In this report, we present the case of a 53-year-old woman with a non-productive cough, progressive dyspnea and fatigue, diagnosed with COVID-19 four weeks earlier. The patient was referred to our department displaying the same symptoms. She was diagnosed with infective endocarditis of the mitral valve based on clinical symptoms, as well as radiological and analytical investigations. The patient was given appropriate medical treatment before admission based on azithromycin, corticosteroids for two weeks, during the hospitalization, she underwent treatment with antibiotics based on Teicoplanin and gentamicin. Outcome was good; the disappearance of the vegetative lesion on the weekly transthoracic echocardiogram (TTE). This rare case highlights questions about considering other coexisting diagnoses as well as possible complications a long with COVID-19.

Pericarditis complicating COVID-19 infection: a report of two cases.

COVID-19 infection is responsible for many complications, which can lead to a high risk of mortality. Respiratory manifestations are the most encountered, while that cardiovascular complications are classified as the most severe. We report two cases of COVID-19 infection complicated by pericarditis. In the absence of other etiology of pericarditis, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was considered as the behind cause. The treatment in these two cases was corticosteroids with colchicine, with good outcomes. In the presence of any cardiovascular symptoms, pericarditis related to COVID-19 should be suspected, in order to act swiftly and avoid complications as well as contamination.

Acute Myocardial Injury Assessed by High-Sensitive Cardiac Troponin Predicting Severe Outcomes and Death in Hospitalized Patients with COVID-19 Infection.

BACKGROUND: Cardiac injury has been linked to a poor prognosis during COVID-19 disease. Nevertheless, the risk factors associated are yet to be thoroughly investigated. OBJECTIVES: We sought to compare demographical characteristics and in-hospital outcomes in patients infected by the SARS-CoV-2 with and without cardiac injury, to further investigate the prevalence of acute cardiac injury as well as its impact on their outcomes in COVID-19-patients. METHODS: We included in a retrospective analysis, all COVID-19 patients admitted between October first and December first, 2020, at the University Hospital Center of Oujda (Morocco) who underwent a troponin assay which was systematically measured on admission. The study population was divided into two groups: cardiac-injured patients and those without cardiac injury. Clinical, biological data and in-hospital outcomes were compared between the two groups. RESULTS: 298 confirmed COVID-19 cases were included. Our study found that compared to non-cardiac-injured, cardiac-injured patients are older, with higher possibilities of existing comorbidities including hypertension (68 [42.2%] vs 40 [29.2%], P = 0.02), diabetes (81 [50.3%] vs 53 [38.7%] P = 0.044), the need for mechanical ventilation, ICU admission and mortality. A Cox proportional hazards regression analysis shows a significantly increased risk of death among cardiac-injured COVID-19-patients as compared to non-cardiac injured. (HR, 1.620 [CI 95%: 2.562-1.024]). CONCLUSION: Our retrospective cohort found that old age, comorbidities, a previous history of CAD, were significantly associated with acute cardiac injury. COVID-19 patients with acute cardiac injury are at a higher risk of ICU admission, and death.

Covid-19 responsible for acute limb ischemia twice at 2 different stages in a patient on anticoagulation: A case report.

INTRODUCTION: Coronavirus disease-2019 is a worldwilde pandemic not limited to pulmonary dysfunction. it is a systemic infection responsible for serious coagulopathies. CASE PRESENTATION: We report the case of a patient who presented an acute ischemia of the left lower limb, after day 5 of (Covid-19) infection, with a second thrombotic localization in the left upper limb at the twentieth day of post covid while he was on anticoagulation. CLINICAL DISCUSSION: Several studies have shown the involvement of the inflammatory process in the thrombotic state in patients with (Covid-19) infection. The inflammatory process leads to the activation of the thrombotic cascade. Various elevated markers have been identified frequently and described to determine the progression of sepsis-induced prothrombotic disease secondary to Covid-19. Our case remains unique in its kind, since the patient presented twice the acute ischemia of the limbs, the first at the left lower limb, while he was on preventive low molecular weight heparin (LMWH), the second time at the left upper limb, while he was on anticoagulation (RIVAROXABAN 20 mg/jr). Although the efficiency of preventive anticoagulation in Covid-19 patients has not been established, it remains systematic as a prescription in the hospital environment. CONCLUSION: All in all, The regular monitoring of vascular markers thrombosis, and preventive anticoagulation remains the only weapon available to any clinician to fight against vascular thrombotic complications in Covid-19 patients, though its realiability has not been proven.

Late-onset mycotic aneurysm of brachial artery secondary to infective endocarditis: case report.

Infective endocarditis remains a dreaded and severe disease because of its course, its complications, its need for good antibiotic management, as well as its morbidity. Peripheral mycotic aneurysm is a rare complication of infective endocarditis. We report the case of a 62-year-old female patient who presented with Streptococcus SPP infective endocarditis treated by antibiotics. Two months later, she presented with a mycotic aneurysm of the right brachial artery with the same germ, we have performed a brachial artery ligation, then a complete revascularization by graft of the saphenous vein. Through this case, we should not forget that the lesional assessment is always necessary to avoid missing serious complications that could threaten the functional prognosis, even vital.

Submitral aneurysm: An unusual localization of aneurysm complicating a myocardial infarction: A case report.

INTRODUCTION: and importance: Submitral aneurysms are an uncommon heart condition that is widespread among young black Africans, congenital etiology is the most common, when SMA is found in patients of other races, other etiologies must be sought, especially ischemic. CASE PRESENTATION: We present the case of a 65-year-old male patient admitted for wide complex tachycardia at a rate of 198 bpm, in whom transthoracic echocardiography revealed a submitral aneurysm and coronary angiography revealed an occlusion of the left circumflex artery. CLINICAL DISCUSSION: Submitral left ventricular aneurysm is a rare cardiac pathology with a variety of causes including inflammation, infection, traumatic illness, or, in rare cases, ischemic heart disease; it can be caused by a congenital defect in the posterior portion of the mitral annulus, which is more common in African population. Clinical manifestations are frequently serious and alarming, such as ventricular tachycardia, cardiogenic shock or an embolic phenomenon; however, asymptomatic cases are possible. CONCLUSION: What we can retain from our case is that SMA can be the cause or consequence of coronary ischemia, so we must be vigilant in patients with an atypical clinical presentation.

Diagnostic Accuracy of D-Dimers for Predicting Pulmonary Embolism in COVID-19-Patients.

IMPORTANCE: Proinflammatory and hypercoagulable states with marked elevation seen in D-Dimer levels have been accurately described in patients infected by the SARS- Cov2 even without pulmonary embolism (PE). OBJECTIVES: To compare D-dimers values in patients infected by the novel Coronavirus 2019 (COVID-19) with and without PE and to establish an optimal D-dimer cut-off to predict the occurrence of PE, which guides pulmonary computed tomography angiography (CTPA) indication. METHODS: We retrospectively enrolled all COVID-19-patients admitted between October first and November 22th, 2020, at the University Hospital Center of Mohammed VI, Oujda (Morocco), suspected to have PE and underwent a CTPA. Demographic characteristics and blood test results were compared between PE-positive and PE-negative. The receiver operating characteristics (ROC) curve was constructed to establish an optimal D-Dimer cut-off to predict the occurrence of PE. RESULTS: The study population consisted of 84 confirmed COVID-19-patients. The mean age was 64.93 years (SD 14.19). PE was diagnosed on CTPA in 31 (36.9%) patients. Clinical symptoms and in-hospital outcomes were similar in both groups except that more men had PE (p = .025). The median value of D-dimers in the group of patients with PE was significantly higher (14 680[IQR 33620-3450]ng/mL compared to the group of patients without PE 2980[IQR 6870-1600]ng/mL [P < .001]. A D-dimer at 2600 ng/mL was the optimal cut-off for predicting PE with a sensitivity of 90.3%, and AUC was .773[CI 95%, .667 -.876). CONCLUSION: A D-dimer cut-off value of 2600 ng/mL is a significant predictor of PE in COVID-19-patients with a sensitivity of 90.3%.

Coronary ectasia due to primary aldosteronism in an exceptional presentation.

Primary aldosteronism as a cause of coronary ectasia has been reported only once in the literature and was associated with an aortic aneurysm. Here, we report a second presentation in our cardiology department - a 59-year-old female patient who was admitted for unstable angina. Coronary angiography revealed an ectasia of two major coronary arteries. An etiological assessment revealed an idiopathic primary aldosteronism.

Popliteal artery entrapment syndrome: a case report with literature review.

Popliteal artery entrapment syndrome generally causes calf claudication in young active adult. It is resulting of the anatomical relationship between the popliteal artery and adjacent muscles or fibrous bands in the popliteal fossa. We present the case of a 36-year-old male with left calf claudication limb in whom popliteal artery entrapment syndrome was diagnosed, and successfully treated surgically.

Adrenal adenoma as a cause of atypical psychosis: Presentation, diagnosis, surgical technique and outcome (case report with a brief literature review).

INTRODUCTION AND IMPORTANCE: Psychiatric symptoms may be a mode of the revelation of several endocrinopathies, but rarely in primary hyperaldosteronism, which can increase psychiatric comorbidity, as well as cardiovascular risk. CASE PRESENTATION: We report a case of a 26-year-old engineer, who suffered from atypical psychosis before being hospitalized for a state of agitation, he presented with high blood pressure and severe hypokalemia. An etiological assessment revealed a right adrenal adenoma, which was afterward resected, with a very good evolution. CLINICAL DISCUSSION: In this association, a high-level of aldosterone and hypokalemia can be behind these manifestations that present in an atypical form. Treatment is medical by anti-aldosterone or surgical by resection of the adenoma, but the challenge now is to know if we can or not stop psychotropic treatment after the treatment of the adenoma. In our case, the treatment was stopped six months after the resection of the adenoma, with very good outcomes until now. CONCLUSION: Despite the high prevalence of psychiatric illnesses, it is always necessary to look for the organic causes that may be behind these pathologies, especially if they are in atypical forms. LEARNING POINTS.

Concomitant acute limb ischemia and multiple acute ischemic strokes complicating COVID-19: a case report.

Since the spread of the coronavirus disease 2019 (COVID-19) pandemic, cardiovascular complications are interestingly increasing, particularly thrombotic events, especially in those requiring intensive care. Venous thromboembolism is well known to occur in patients infected by the SARS-CoV-2, but only a few arterial thromboembolism cases have been previously reported. Herein, we report the case of a COVID-19 complicated by a concomitant acute right limb ischemia and multiple acute ischemic strokes. This rare case emphasizes the hypercoagulable state described in COVID-19 patients and the need for anticoagulation therapy to prevent these severe complications.

Multiple paradoxical embolisms revealing a patent foramen ovale in a patient with deep venous thrombosis: A case report.

INTRODUCTION: Paradoxical embolism is a rare medical phenomenon. Depending on the site of embolisation, it can cause different symptoms. Although rare, mesenteric ischemia can reveal paradoxical embolism, and the embolisation of two different sites is rarely described in the literature. CASE PRESENTATION: We report the observation of a patient with a table associating an acute mesenteric ischemia and an acute ischemia of the upper limb; whose the etiological assessment revealed a deep venous thrombosis of the lower limbs complicated by pulmonary embolism. CLINICAL DISCUSSION: These paradoxical embolisms occurred through a patent foramen ovale. The diagnosis of the patent foramen ovale in this patient was revealed by transthoracic echocardiography, with bubble test. The patient benefited from an embolectomy of the superior mesenteric artery and an embolectomy using fogarty catheter by approching humeral artery at the elbow crease with good postoperative evolution. The patient was put on long-term anticoagulation with Acenocoumarol (because of low socio-economic level of our patient). We didn't recommended the closure of the PFO because of the small size of the shunt and especially because the patient refuses that procedure. CONCLUSION: Paradoxical embolism remains a pathology rarely mentioned by clinicians, although it can engage the functional and vital prognosis of the patient, hence the interest of a good cardiac evaluation in any patient with embolic ischemia.

Late-onset of pulmonary embolism following hospitalization for COVID-19 despite thromboprophylaxis: a report of two cases.

The global pandemic caused by the SARS-CoV-2 has resulted in an increased incidence of venous thromboembolism among hospitalized COVID-19-patients, especially those who required intensive care, despite thromboprophylaxis. This has resulted in the use of higher doses of thromboprophylaxis or therapeutic anticoagulation therapy even in the absence of thrombotic events. However, after their hospital discharge, authors and current guidelines are not unanimous about extended anticoagulant therapy in patients with COVID-19. Here, we report two pulmonary embolism cases following hospitalization for COVID-19, despite intermediate doses of thromboprophylaxis. These rare cases suggest that there may be a residual thrombotic risk following hospitalization for COVID-19 and highlight questions about extended prophylactic-anticoagulation therapy after hospital discharge of patients with COVID-19.

Multiple cardiovascular complications of COVID-19 infection in a young patient: a case report.

COVID-19 infection is responsible for many complications, which can lead to a high risk of mortality in some patients. Among them are cardiovascular complications which are classified as the most severe. We report a case of a young woman, with no relevant pathological history, admitted for COVID-19 infection, complicated by myocarditis with severe ventricular dysfunction, cardiogenic shock and a large thrombosis into the left ventricle (LV) that was responsible for a left lower limb ischemia associated with a deep venous thrombosis of right lower limb.

Acute myocardial infarction in a 41-year-old woman due to elevated factor VIII: a case report.

Myocardial infarction is a life-threatening emergency with a high mortality rate. A high plasma level of factor VIII is an established risk for both arterial and venous thrombotic events. In this mini-review, we report the case of a 41-year-old woman without cardiovascular risk factors or a previous history of thrombotic events, admitted for ST-elevation myocardial infarction, in whom coronary angiography showed a thrombotic occlusion in the left anterior descending artery. The patient underwent primary percutaneous coronary intervention (PCI), with GPIIB-IIIA antagonist, then, a pre-dilation with a semi-compliant balloon-catheter, followed by implantation of 2 stents. The etiological assessment revealed a high level of coagulation factor VIII (FVIII). She underwent anticoagulation therapy (with acenocoumarol) with well-controlled international normalised ratio (INR).

Bilateral Pulmonary Embolism in Patients Recovered From Asymptomatic COVID-19 Infection.

Hypercoagulability state is common in patients with coronavirus disease 2019 (COVID-19), especially those requiring intensive care. Indeed, anticoagulation therapy is recommended for all hospitalized COVID-19-patients. Despite well-conducted thromboprophylaxis, so many patients have developed these life-threatening complications. However, these thrombotic events are not known to occur in asymptomatic COVID-19 patients or in those recovered from active severe acute respiratory syndrome coronavirus 2 infection. This case series of a bilateral pulmonary embolism that occurred in patients recovered from asymptomatic COVID-19 highlights the questions about extending thromboprophylaxis in ambulatory patients with COVID-19.

Rare and Underestimated Association of Pulmonary Embolism and Olanzapine Therapy; Report of Two Cases.

Venous thromboembolic disease (VTD) is a very common and severe pathological condition in which there are many predisposing factors. Olanzapine is a drug frequently used in psychiatric practises; it is thought to increase the risk of VTD. Here, we report two cases, a young man and a woman, with a medical history of schizophrenia treated by olanzapine who developed pulmonary embolism and we did not find any aetiologies of VTD in them. Due to the link between olanzapine and pulmonary embolism, which has been previously described, olanzapine is considered responsible for this problem. Two mechanisms have been reported in the literature in this regard; significant weight gain and lethargy, which are very common side effects of olanzapine. So far, no direct effect of olanzapine on platelet aggregation or coagulation has been found. In patients developing VTD while being treated with olanzapine, discontinuation of olanzapine as a treatment option must be done with an adjustment of antipsychotic treatment and regular monitoring of psychic symptoms. Since the diagnosis of pulmonary embolism is not easy to make in a schizophrenic patient, clinicians should take that in consideration when prescribing these drugs and when facing clinical situations where VTD is suspected.

Right-Sided Cardiac Hydatid Cyst Complicated With Pulmonary Embolization: A Pediatric Case Report.

Echinococcosis is an endemic zoonotic parasitic infection found in Morocco, due to Echinococcus granulosus. Cardiac localization is a rare form, presenting in various ways. The right heart is an uncommon site of cardiac involvement. We report a case of a right-sided cardiac hydatid cyst complicated with multiple pulmonary embolism, revealed by dyspnea at rest, in a 15-year-old male. The patient successfully underwent surgical removal which confirmed the diagnosis. This case report demonstrates one of the various clinical presentations of this condition, and the importance of early treatment in order to prevent its potentially fatal complications, particularly in the young.