Research Square: COVID-19 presented with Deep Vein Thrombosis: An unusual case report

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Background

On 31 December 2019, the World Health Organization (WHO) was informed of a cluster of cases of pneumonia of unknown cause detected in Wuhan City, Hubei Province, China. The pneumonia was caused by a virus called SARS-Cov-2, which was later named COVID-19. In this report, we present a patient with COVID-19 who developed deep vein thrombosis.

Case presentation

A 57-year-old woman presented to the clinic’s infectious department with no underlying illness due to pain, redness, and leg swelling. According to a patient report, she had a mild dry cough for the past 3 days and had no other symptoms. The patient had no history of prone thrombosis conditions. Initially, CT angiography was performed to rule out pulmonary thromboembolism, which showed no evidence of thrombosis. Dilatation and thrombosis were seen in the examinations of the paired veins of the leg, popliteal, superficial and left femoral joints, and no evidence of vascular flow suggesting acute DVT. Because of fever and lymphopenia, nasal swabs were used for sampling and SARS-CoV-2 nucleic acid was detected by RT-PCR. Chest X-ray also revealed bilateral patchy ground-glass opacity. Other tests including ANA, Anti-dsDNA, RF test and ACA test was normal. Heparin at a dose of 80 units/kg IV bolus, chloroquine 400 mg single dose and lopinavir/ritonavir (Kaletra) 400 mg twice daily were prescribed to treat illness and relieve symptoms. On illness day 3, fever stopped and nasal swab sample turned undetectable for SARS-CoV-2 by RT-PCR as well as swelling and tenderness on her leg had been disappeared gradually. She is under regular follow-up with no new symptoms to date.

Conclusion

The mechanism of DVT formation due to COVID-19 is unknown despite thrombocytopenia, and has not been investigated but it resolved as COVID-19 symptoms, tenderness, and leg pain improved. Although COVID-19 presented with Deep Vein Thrombosis is a rare condition, in middle-aged people with sudden onset of manifestations, we should recognize it from other diseases as an important and treatable differential diagnosis. Rapid diagnostic assays, efficient treatment, and prudent use of CT-scan are important to control future COVID-19 spread.

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