Faculty of Medicine, McGill University, Montreal, Canada.
Department of Medicine, University of Montreal, Montreal, Canada.
J Thromb Thrombolysis. 2021 Jan;51(1):25-28. doi: 10.1007/s11239-020-02173-w.
Acute viral pneumonia, hypoxemic respiratory failure and severe inflammatory response are hallmarks of severe coronavirus disease 2019 (COVID-19). The COVID-19-associated inflammatory state may further lead to symptomatic thromboembolic complications despite prophylaxis. We report a 66-year-old female patient with post-mortem diagnosis of COVID-19 who presented progressive livedo racemosa, acute renal failure and myocardial injury, as well as an absence of respiratory symptoms. Transthoracic echocardiography showed severe spontaneous echo contrast in the right cardiac chambers and right-sided cardiac overload presumed to result from pulmonary microvascular thrombosis or embolism. D-dimer levels were increased. The patient developed an acute ischemic stroke and died 2 days following presentation despite therapeutic anticoagulation. Her predominantly thromboembolic presentation supports the concept of coronavirus infection of endothelial cells and hypercoagulability, or COVID-19 endotheliitis. The case we report highlights that COVID-19-associated hyperacute multi-organ thromboembolic storm may precede or present disproportionately to respiratory involvement.
急性病毒性肺炎、低氧性呼吸衰竭和严重炎症反应是严重 2019 年冠状病毒病（COVID-19）的标志。COVID-19 相关的炎症状态可能会导致有症状的血栓栓塞并发症，尽管进行了预防。我们报告了一例 66 岁女性患者，COVID-19 死后诊断为进行性网状青斑、急性肾功能衰竭和心肌损伤，且无呼吸系统症状。经胸超声心动图显示右心腔和右侧心脏负荷严重自发性回声对比，推测是由于肺微血管血栓形成或栓塞所致。D-二聚体水平升高。尽管进行了治疗性抗凝，该患者仍在出现症状后 2 天发生急性缺血性卒中并死亡。她主要表现为血栓栓塞，支持冠状病毒感染内皮细胞和高凝状态，或 COVID-19 血管内皮炎的概念。我们报告的病例强调 COVID-19 相关的超急性多器官血栓栓塞风暴可能先于或不成比例地发生于呼吸受累。
