Aspirin
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Gastrointestinal system bleeding: case report A 53-year-old man developed gastrointestinal system (GIS) bleeding during treatment with aspirin. The man, who had a medical history of diabetes mellitus, hypertension and chronic renal failure, presented to an emergency department of a hospital in Turkey with diarrhoea, epigastric pain and dyspnoea. He had presented to the emergency department due to epigastric pain and dyspnoea 2 days previously, and a nasal swab was taken for coronavirus disease (COVID-19). Also, he had started receiving unspecified symptomatic treatment. He (currently) presented again because the complaints had not regressed, and he had also developed diarrhoea. He had palpitation and black stool along with dyspnoea. He had not recently travelled outside of the state or country, and there had been no contact with any COVID-19 positive patient. He had a history of using aspirin [acetylsalicylic acid; route, dosage and indication not stated]. The heart was tachycardic and rhythmic, and an ECG demonstrated sinus tachycardia and ischaemia in the inferolateral derivation. Abdominal examination revealed epigastric tenderness, and melaena was observed in rectal examination. The laboratory values showed that he had anaemia and an increase in white blood cell, creatinine, blood urea nitrogen, glucose, LDH, procalcitonin and highly sensitive Troponin I values. The COVID-19 RT-PCR test (taken 2 days previously) was found to be positive. It was noted that the diarrhoea was GIS bleeding, and ulceration of the GI was also present . Therefore, the man was admitted in the private and isolated service. He started receiving pantoprazole for the GIS bleeding. Also, he started receiving an off-label therapy with hydroxychloroquine for the COVID-19 treatment. He received erythrocytes [red blood cell] transfusion when the haemoglobin level reduced (7.2 g/dL) in the control haemogram. Segmental and global wall motion abnormality was not observed. At a follow-up, the cardiac enzymes had regressed, and the ECG did not change. The haemoglobin levels had not decreased after the transfusion. He was discharged on hospital day 7, and 14 days of home isolation was recommended. A subsequent nasal swab sample (14 days following the first application) tested negative. It was noted that he had developed GIS bleeding secondary to the mucosal damage caused by aspirin. Additionally, the direct COVID-19 virus attack was considered to have initiated the necrosis and degeneration in the GI mucosa, leading to ulceration and bleeding. He was scheduled for cardiology and gastroenterology outpatient control 2 weeks following discharge [outcome of ADR not stated]. Gulen M, et al. Uncommon presentation of COVID-19: Gastrointestinal bleeding. Clinics and Research in Hepatology and Gastroenterology 44: e72-e76, No. 4, Sep 2020. 803503146 Available from: URL: http://doi.org/10.1016/j.clinre.2020.05.001
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Reactions 26 Sep 2020 No. 1823
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