key: cord-0706239-cwn6lrgk
authors: Castro, Gustavo Rodrigues Alves; Collaço, Iwan Augusto; Dal Bosco, Caroline L. Balcewicz; Corrêa, Gustavo Gusso; Dal Bosco, Giovana Balcewicz; Corrêa, Giovana Luiza
title: Splenic infarction as a complication of covid-19 in a patient without respiratory symptoms: A case report and literature review
date: 2021-03-20
journal: IDCases
DOI: 10.1016/j.idcr.2021.e01062
sha: c4bf3c78849e65202de038e2de3f5655b0bca070
doc_id: 706239
cord_uid: cwn6lrgk

INTRODUCTION: Multiple studies suggest that SARS-CoV-2 infection is associated with a pro-thrombotic state and thrombotic events have been recorded in several organs and systems. We report a patient with no respiratory symptoms, presented with abdominal pain and an extensive splenic infarction after COVID-19. CASE REPORT: A 67 year-old man was admitted to the emergency department with a moderate, dull, left-sided abdominal pain. The patient denied respiratory symptoms but referred contact with family members positive for COVID-19. He tested positive for COVID-19 and had increased D-dimer levels. Imaging studies revealed splenic infarcts and ground-glass opacities in bilateral pulmonary bases. He was treated with full-dose anticoagulation and was discharged home on oral Rivaroxaban. DISCUSSION: Although rare in the literature, cases of acute abdomen in COVID-19 patients associated with vascular infarctions have increased. Coagulopathy may be present even without clinical respiratory manifestations of the disease. Patients meeting disseminated intravascular coagulation criteria or with markedly elevated D-dimer may benefit from anticoagulant therapy. CONCLUSION: Clinicians should suspect of abdominal visceral infarctions in COVID-19 patients presented with acute abdominal pain, despite the absence of respiratory symptoms.

The COVID-19 pandemic is a challenge for health systems worldwide.

Although a majority of infected patients remain asymptomatic or have mild to moderate respiratory disease, several complications and new clinical presentations related to SARS-CoV-2 infection are described every day. 1, 2 Multiple studies suggest that SARS-CoV-2 infection is associated with a pro-thrombotic state and an increased risk for venous and arterial thromboembolism 3, 4 . Among the most commonly found abnormal coagulation parameters are elevated D-dimer and platelet count with low antitrombin levels. 5 Thrombotic events have been recorded in several organs and systems: pulmonary embolism has been the event most commonly associated with COVID-19. However, more recently, abdominal visceral infarctions have been reported including splenic infarction, renal infarction and intestinal ischemia. 5 Splenic infarction is a rare disorder that can present as left-abdominal pain and may be secondary to hypercoagulable states. 5 To date, clinical cases of COVID-19 with splenic infarction are rare in the literature.

In this article we report a case of a previously healthy patient, with clinical manifestations of an acute abdomen and presenting an extensive splenic infarction after infection by SARS-CoV-2.

A 67 year-old man was admitted to the emergency department with a moderate, dull, left-sided abdominal pain. The pain had 12 days of evolution, In a series of cases with patients infected with SARS-CoV-2 in Brazil, patients had respiratory symptoms associated with splenic, pulmonary and brain infarctions, confirmed by imaging tests. 4 

In the present report, we describe a case of splenic infarction in a patient with non-respiratory manifestations of COVID-19, which reinforces that coagulopathy may be present even without clinical respiratory manifestations of the disease.

patients presented with acute abdominal pain.

This research did not receive any specific grant from funding agencies in

COVID-19: Are we dealing with a multisystem vasculopathy in disguise of a viral infection?

A case report on spontaneous hemoperitoneum in COVID-19 patient

Thromboinflammatory response in SARS-CoV-2 sepsis

Multisystemic Infarctions in COVID-19: Focus on the Spleen

Acute Splenic Artery Thrombosis and Infarction Associated with COVID-19 Disease. Case Rep Crit Care

Splenic infarcts as a rare manifestation of parvovirus B19 infection

Concomitant renal and splenic infarction as a complication of COVID-19: a case report and literature review

COVID-19 coagulopathy: An indepth analysis of the coagulation system

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