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病例报告:2019冠状病毒病(COVID-19)肺炎合并多发性血栓栓塞

Case Report: The Coronavirus Disease 2019 (COVID-19) Pneumonia With Multiple Thromboembolism.

作者信息

Cao Tingting, Zhang Guqin, Xie Huabing, Pellegrini Emily, Li Jin, Chen Xiaoxing, Pan Huaqin

机构信息

Department of Gastroenterology, Zhongnan Hospital of Wuhan University, Wuhan, China.

Department of Respiratory and Critical Care Medicine, Zhongnan Hospital of Wuhan University, Wuhan, China.

出版信息

Front Neurol. 2021 Jan 12;11:625272. doi: 10.3389/fneur.2020.625272. eCollection 2020.

DOI:10.3389/fneur.2020.625272
PMID:33551979
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC7859614/
Abstract

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) broke out in Wuhan, China, in late December 2019 and has since spread rapidly around the world. Severe coronavirus disease 2019 (COVID-19) pneumonia patients have abnormal blood coagulation function, but their thromboembolism prevalence is still unknown. We reported a case of a 49-year-old man infected with COVID-19, presenting with fever, chest pain, limb weakness, myalgia, and dyspnea. The patient was diagnosed with severe COVID-19 pneumonia, pulmonary thromboembolism (PTE), deep vein thrombosis (DVT), and cerebral infarction. He received supportive and empirical treatment including anticoagulant treatment, anti-inflammatory treatment, oxygen supply, and inhalation therapy. The patient's symptoms, CT images, and laboratory results improved after treatment, and a throat swab was reported to be negative for SARS-CoV-2 virus by polymerase chain reaction (PCR) test. However, on day 51 of illness onset, CT reexamination demonstrated hemorrhagic infarction. Anticoagulant therapy was discontinued temporarily. After the patient tested negative for SARS-CoV-2 virus by PCR test six more times, he was discharged and remained in home quarantine. This case highlights the importance of clinician attentiveness to the appearance of multiple thromboembolism, especially in patients with severe pulmonary damage. It also emphasizes the diagnostic value of early CT imaging and the need for effective treatment once thrombotic events occur.

摘要

2019年12月下旬,严重急性呼吸综合征冠状病毒2(SARS-CoV-2)在中国武汉爆发,此后迅速在全球传播。2019冠状病毒病(COVID-19)重症肺炎患者存在凝血功能异常,但其血栓栓塞的患病率仍不清楚。我们报告了1例感染COVID-19的49岁男性病例,其表现为发热、胸痛、肢体无力、肌痛和呼吸困难。该患者被诊断为重症COVID-19肺炎、肺血栓栓塞症(PTE)、深静脉血栓形成(DVT)和脑梗死。他接受了包括抗凝治疗、抗炎治疗、供氧和吸入治疗在内的支持性及经验性治疗。治疗后患者的症状、CT图像和实验室检查结果有所改善,经聚合酶链反应(PCR)检测,咽拭子SARS-CoV-2病毒报告为阴性。然而,在发病第51天,CT复查显示出血性梗死。抗凝治疗暂时中断。该患者经PCR检测6次SARS-CoV-2病毒均为阴性后出院,继续居家隔离。该病例突出了临床医生关注多重血栓栓塞出现的重要性,尤其是在严重肺损伤患者中。它还强调了早期CT成像的诊断价值以及血栓事件发生后有效治疗的必要性。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/4fb2/7859614/79c9aec2ea44/fneur-11-625272-g0002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/4fb2/7859614/771059f00303/fneur-11-625272-g0001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/4fb2/7859614/79c9aec2ea44/fneur-11-625272-g0002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/4fb2/7859614/771059f00303/fneur-11-625272-g0001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/4fb2/7859614/79c9aec2ea44/fneur-11-625272-g0002.jpg

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