COVID-19 and Pulmonary Embolism: Not a Coincidence
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A 50-year-old man was referred to the emergency department with a 2-day history of fever and sore throat. He also had constitutional symptoms including myalgia, rhinorrhoea, cough and headache. His medical history was otherwise significant for chronic kidney disease, hypertension and hepatitis B (HBV). He was being treated with candesartan/hydrochlorothiazide and entecavir.

He complained of palpitations, shortness of breath and chest pain, and oxygen saturation dropped to 90%. The ECG showed a tachycardic sinus rhythm and negative T waves in lateral derivations, which were not previously present. Blood tests showed high sensitivity cardiac troponin (hs Tc) in the normal range but D-dimer elevated at 2.7 mg/l. In light of the symptoms and ECG alterations, coronary angiography was performed, but was negative.

A pulmonary angiography CT scan documented the presence of a bilateral filling defect diagnostic for pulmonary embolism, and associated with extensive ground-glass opacifications involving both lung parenchyma with predominant consolidation in the posterior basal segment of the right lower lobe. Lower-limb compression ultrasonography was negative. Transthoracic echocardiography (TTE) was normal. Based on these findings, treatment with enoxaparin was started and the patient was closely monitored. He remained haemodynamically stable and was transitioned to oral anticoagulant therapy with rivaroxaban.

In patients affected by SARS-CoV-2 infection, particular attention should therefore be paid to possible vascular complications in order to prevent clinical deterioration and death.


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