A young COVID-19 patient with mild symptoms and disseminated intravascular coagulation

Authors

  • Abhishek Kumar Department of Medicine, Rajendra Institute of Medical Sciences, Ranchi, Jharkhand, India http://orcid.org/0000-0001-8110-7966
  • Piyush Kumar Department of Medicine, Rajendra Institute of Medical Sciences, Ranchi, Jharkhand, India
  • Ajit Dungdung Department of Medicine, Rajendra Institute of Medical Sciences, Ranchi, Jharkhand, India

DOI:

https://doi.org/10.18203/2320-6012.ijrms20204918

Keywords:

Disseminated intravascular coagulation, COVID-19, Thrombosis, Coagulopathy

Abstract

Covid-19 pandemic in recent times has emerged as a major contributor to multisystemic thrombosis and related complications. Covid-19 leads to a syndrome of generalised systemic coagulopathy and acquired thrombophilia which manifests itself in the form of arterial, venous and microvascular thrombosis. The pathological mechanisms for covid-19 induced coagulopathy are yet to be clear however extensive research is underway and multiple insights have emerged recently. Here we report a case of young Covid-19 patient who presented with mild fever but severely deranged coagulation parameters and inflammatory markers. He was managed conservatively with Low molecular weight heparin, Fresh frozen plasma, Tab HCQS, Tab Doxycycline, Tab Ivermectin, Tab Zinc, Tab Vitamin C and responded well to treatment. He was later discharged after testing covid-19 negative. Screening of all confirmed cases for coagulopathy like D-dimer, FDP, platelet count, Prothrombin time may be done to identify high risk asymptomatic/mild cases which may cause further decrease in mortality.

Author Biographies

Abhishek Kumar, Department of Medicine, Rajendra Institute of Medical Sciences, Ranchi, Jharkhand, India

MBBS, Junior Resident (PGY-3), Department of Medicine

Piyush Kumar, Department of Medicine, Rajendra Institute of Medical Sciences, Ranchi, Jharkhand, India

MBBS, Junior Resident (PGY-3), Department of Medicine

Ajit Dungdung, Department of Medicine, Rajendra Institute of Medical Sciences, Ranchi, Jharkhand, India

MD, Associate Professor, Department of Medicine

References

World Health Organization. Pneumonia of unknown cause—China. 2020. Available at: https://www. who.int/csr/don/05-january-2020-pneumonia-of-unkown-cause-china/en/. Accessed on 07 May 2020

World Health Organization. WHO Director-General’s remarks at the media briefing on 2019-nCoV on 11 February 2020. Available at: https://www.who.int/dg/speeches/detail/whodirector-general-s-remarks-at-the-media-briefing-on-2019-ncovon-11-february-2020. Accessed 20 February 2020.

Covid19.who.int. 2020. WHO Coronavirus Disease (COVID-19) Dashboard. Available at: https:// covid19.who.int/table. Accessed on 02 February 2020.

Lotfi M, Hamblin MR, Rezaei N. COVID-19: Transmission, prevention, and potential therapeutic opportunities. Clin Chim Acta. 2020;508:254-266.

Wang Y, Wang Y, Chen Y, Qin Q. Unique epidemiological and clinical features of the emerging 2019 novel coronavirus pneumonia ( COVID-19) implicate special control measures. J Med Virol. 2020;92(6):568-76.

Asadi-Pooya AA, Simani L. Central nervous system manifestations of COVID-19: A systematic review. J Neurol Sci. 2020;413:116832.

Stefanini GG, Montorfano M, Trabattoni D, Andreini D, Ferrante G, Ancona M, et al. ST-Elevation Myocardial Infarction in Patients With COVID-19: Clinic Angiograp Outcom. Circulat. 2020;141(25):2113-6.

Montalvan V, Lee J, Bueso T, De Toledo J, Rivas K. Neurological manifestations of COVID-19 and other coronavirus infections: A systematic review. Clin Neurol Neurosurg. 2020;194:105921.

Bryce C, Grimes Z, Pujadas E, Ahuja S, Beasley MB, Albrecht R, et al. Pathophysiology of SARS-CoV-2: targeting of endothelial cells renders a complex disease with thrombotic microangiopathy and aberrant immune response. The Mount Sinai COVID-19 autopsy experience. Med Rxiv. 2020.

Carsana L, Sonzogni A, Nasr A, Rossi RS, Pellegrinelli A, Zerbi P, et al. Pulmonary post-mortem findings in a series of COVID-19 cases from northern Italy: a two-centre descriptive study. Lanc Infect Diseas. 2020.

Kow CS, Hasan SS. Use of low-molecular-weight heparin in COVID-19 patients. J Vasc Surg Venous Lymphat Disord. 2020;8(5):900-1.

Kinasewitz GT, Zein JG, Lee GL, Nazir SA, Taylor FB Jr. Prognostic value of a simple evolving disseminated intravascular coagulation score in patients with severe sepsis. Crit Care Med. 2005;33(10):2214-21.

Monteil V, Kwon H, Prado P, Hagelkrüys A, Wimmer RA, Stahl M, et al. Inhibition of SARS-CoV-2 Infections in Engineered Human Tissues Using Clinical-Grade Soluble Human ACE2. Cell. 2020;181(4):905-13.

Sharma A, Garcia G, Arumugaswami V, Svendsen CN. Human iPSC-Derived Cardiomyocytes are Susceptible to SARS-CoV-2 Infection. Bio Rxiv [Preprint]. 2020:2020.

Brill A, Fuchs TA, Savchenko AS, Thomas GM, Martinod K, De Meyer SF, et al. Neutrophil extracellular traps promote deep vein thrombosis in mice. J Thromb Haemost. 2012;10(1):136-44.

Escher R, Breakey N, Lämmle B. Severe COVID-19 infection associated with endothelial activation. Thromb Res. 2020;190:62.

Becker RC. COVID-19 update: COVID-19-associated coagulopathy. J Thromb Thrombolysis. 2020;50(1):54-67.

Tang N, Li D, Wang X, Sun Z. Abnormal coagulation parameters are associated with poor prognosis in patients with novel coronavirus pneumonia. J Thromb Haemost. 2020;18(4):844-7.

Zhou F, Yu T, Du R, Fan G, Liu Y, Liu Z, et al. Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study. Lanc. 2020;395(10229):1054-62.

Helms J, Tacquard C, Severac F, Leonard-Lorant I, Ohana M, Delabranche X, et al. CRICS TRIGGERSEP Group (Clinical Research in Intensive Care and Sepsis Trial Group for Global Evaluation and Research in Sepsis). High risk of thrombosis in patients with severe SARS-CoV-2 infection: a multicenter prospective cohort study. Intens Car Med. 2020;46(6):1089-98.

Gao Y, Li T, Han M, Li X, Wu D, Xu Y, et al. Diagnostic utility of clinical laboratory data determinations for patients with the severe COVID-19. J Med Virol. 2020;92(7):791-6.

Chai X, Hu L, Zhang Y, Han W, Lu Z, Ke A, et al. Specific ACE2 expression in cholangiocytes may cause liver damage after 2019-nCoV infection. biorxiv. 2020 Jan 1.

Chen N, Zhou M, Dong X, Qu J, Gong F, Han Y, et al. Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: a descriptive study. Lanc. 2020;395(10223):507-13.

Fan Z, Chen L, Li J, Cheng X, Yang J, Tian C, et al. Clinical Features of COVID-19-Related Liver Functional Abnormality. Clin Gastroenterol Hepatol. 2020;18(7):1561-6.

Zhai Z, Li C, Chen Y, Gerotziafas G, Zhang Z, Wan J, et al. Prevention Treatment of VTE Associated with COVID-19 Infection Consensus Statement Group. Prevention and Treatment of Venous Thromboembolism Associated with Coronavirus Disease 2019 Infection: A Consensus Statement before Guidelines. Thromb Haemost. 2020;120(6):937-48.

Barnes GD, Burnett A, Allen A, Blumenstein M, Clark NP, Cuker A, et al. Thromboembolism and anticoagulant therapy during the COVID-19 pandemic: interim clinical guidance from the anticoagulation forum. J Thromb Thrombol. 2020;50(1):72-81.

Downloads

Published

2020-10-28

How to Cite

Kumar, A., Kumar, P., & Dungdung, A. (2020). A young COVID-19 patient with mild symptoms and disseminated intravascular coagulation. International Journal of Research in Medical Sciences, 8(11), 4130–4133. https://doi.org/10.18203/2320-6012.ijrms20204918

Issue

Section

Case Reports