Department of Medicine, Abington Hospital-Jefferson Health, Abington, PA, USA.
J Med Case Rep. 2021 Mar 2;15(1):112. doi: 10.1186/s13256-021-02692-x.
Severe acute respiratory syndrome coronavirus 2 infection can lead to a constellation of viral and immune symptoms called coronavirus disease 2019. Emerging literature increasingly supports the premise that severe acute respiratory syndrome coronavirus 2 promotes a prothrombotic milieu. However, to date there have been no reports of acute aortic occlusion, itself a rare phenomenon. We report a case of fatal acute aortic occlusion in a patient with coronavirus disease 2019.
A 59-year-old Caucasian male with past medical history of peripheral vascular disease presented to the emergency department for evaluation of shortness of breath, fevers, and dry cough. His symptoms started 5-7 days prior to the emergency department visit, and he received antibiotics in the outpatient setting without any effect. He was found to be febrile, tachypneic, and hypoxemic. He was placed on supplemental oxygen via a non-rebreather mask. Chest X-ray showed multifocal opacifications. Intravenous antibiotics for possible pneumonia were initiated. Hydroxychloroquine was initiated to cover possible coronavirus disease 2019 pneumonia. During the hospitalization, the patient became progressively hypoxemic, for which he was placed on bilevel positive airway pressure. D-dimer, ferritin, lactate dehydrogenase, and C-reactive protein were all elevated. Severe acute respiratory syndrome coronavirus 2 reverse transcription polymerase chain reaction was positive. On day 3, the patient was upgraded to the intensive care unit. Soon after he was intubated, he developed a mottled appearance of skin, which extended from his bilateral feet up to the level of the subumbilical plane. Bedside ultrasound revealed an absence of flow from the mid-aorta to both common iliac arteries. The patient was evaluated emergently by vascular surgery. After a discussion with the family, it was decided to proceed with comfort-directed care, and the patient died later that day.
Viral infections have been identified as a source of prothrombotic states due to direct injury of vascular tissue and inflammatory cascades. Severe acute respiratory syndrome coronavirus 2 appears to follow a similar pattern, with numerous institutions identifying elevated levels of thrombotic complications. We believe that healthcare providers should be aware of both venous and arterial thrombotic complications associated with coronavirus disease 2019, including possible fatal outcome.
严重急性呼吸综合征冠状病毒 2 感染可导致一系列病毒和免疫症状，称为 2019 年冠状病毒病。越来越多的新兴文献支持这样一种前提，即严重急性呼吸综合征冠状病毒 2 促进了促血栓形成环境。然而，迄今为止，尚无急性主动脉闭塞的报道，而急性主动脉闭塞本身就是一种罕见现象。我们报告了一例 2019 年冠状病毒病患者的致命性急性主动脉闭塞病例。
一名 59 岁白人男性，既往有周围血管疾病病史，因呼吸急促、发热和干咳到急诊科就诊。他的症状在急诊科就诊前 5-7 天开始，在门诊接受了抗生素治疗，但没有效果。他发热、呼吸急促、低氧血症。他被给予非重复呼吸面罩补充氧气。胸部 X 线显示多灶性混浊。静脉注射抗生素治疗可能的肺炎。给予羟氯喹以覆盖可能的 2019 年冠状病毒病肺炎。住院期间，患者进行性低氧血症，为此他被置于双水平气道正压通气。D-二聚体、铁蛋白、乳酸脱氢酶和 C 反应蛋白均升高。严重急性呼吸综合征冠状病毒 2 逆转录聚合酶链反应为阳性。第 3 天，患者被转至重症监护病房。他刚被插管后，就出现了皮肤斑驳的外观，从他的双侧脚延伸到脐以下平面。床边超声显示从中主动脉到双侧髂总动脉均无血流。血管外科紧急对患者进行了评估。与家属讨论后，决定进行舒适导向治疗，患者当天晚些时候死亡。
病毒感染已被确定为促血栓形成状态的来源，原因是血管组织的直接损伤和炎症级联反应。严重急性呼吸综合征冠状病毒 2 似乎也遵循类似的模式，许多机构都发现了升高的血栓并发症水平。我们认为，医疗保健提供者应该意识到与 2019 年冠状病毒病相关的静脉和动脉血栓并发症，包括可能的致命后果。
