Late onset pulmonary embolism in young male otherwise healthy COVID-19 patients
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Late onset pulmonary embolism in young male otherwise healthy COVID-19 patients M. Karolyi 1 & E. Pawelka 1 & S. Omid 1 & H. Kelani 1 & T. Mader 1 & S. Baumgartner 1 & H. Laferl 1 & M. Traugott 1 & T. Seitz 1 & A. Zoufaly 1 & C. Wenisch 1 Received: 15 May 2020 / Accepted: 18 September 2020 # Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract SARS-CoV-2 infection is associated with increased risk of thrombosis in severely ill patients but little is known about the risk in outpatients with mild to moderate disease. Our case series consists of four male otherwise healthy patients between 32 and 50 years of age. Initial symptoms completely resolved but they developed new onset of dyspnea and thoracic pain at days 14 to 26. CT scan revealed pulmonary embolism in all patients which led to hospitalization. Standard anticoagulation practice needs to be re-evaluated and may be considered for certain outpatients with COVID-19. Keywords COVID-19 . Pulmonary embolism . Outpatients . SARS-CoV-2 . Anticoagulation . Late onset
Introduction The SARS-CoV-2 pandemic led to more than 290,000 deaths worldwide, by May 14, 2020 (https://www.ecdc.europa.eu/ en/geographical-distribution-2019-ncov-cases). Several risk factors for severe disease and mortality have been identified, e.g., advanced age, higher SOFA score, elevated Ferritin and LDH, number of comorbidities, decreased lymphocyte count, hypoalbuminemia, and elevated D-Dimer levels [1, 2]. Abnormal coagulation parameters are a key feature of COVID-19 especially in critically ill patients. One study showed that 78% of non-survivors fulfilled the laboratory criteria of DIC [3]. Studies showed reduced mortality in hospitalized COVID-19 patients treated vs not treated with anticoagulants in patients with a sepsis-induced-coagulopathy (SIC) score ≥ 4 or D-Dimer > 6 times upper limit of normal [4]. Thromboprophylaxis via low-weight-molecular heparin (LWMH) in hospitalized patients is commonly practiced but usually not considered necessary in outpatients. We might have to revaluate this practice in COVID-19 patients and consider prophylactic anticoagulation even in mild cases treated * M. Karolyi [email protected] 1
Department for Infectious Diseases and Tropical Medicine, Kaiser-Franz-Josef Hospital, Kundratstraße 3, 1100 Vienna, Austria
on an outpatient basis. We describe a case series of four outpatients with proven SARS-CoV-2 infection who developed pulmonary embolism (PE) with a delay of 2–4 weeks after symptom onset with complete resolution of initial symptoms.
Methods Four patients with suspected COVID-19 who did not need initial hospitalization were visited by mobile SARS-CoV-2 sampling teams in Vienna, Austria. Those trained professionals collected nasopharyngeal swabs and diagnosis of COVID-19 was made via SARS-CoV-2 PCR in certified laboratories. After initial resolution of symptoms patients had to be admitted to the Kaiser-Franz-Josef Hospital because of new onset of symptoms. This hospital is the main treating facility for proven SA
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