Spontaneous muscle hematoma in older patients with COVID-19: two case reports and literature review
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CASE REPORT
Open Access
Spontaneous muscle hematoma in older patients with COVID-19: two case reports and literature review Sara Rogani†, Valeria Calsolaro†, Riccardo Franchi, Alessia Maria Calabrese, Chukwuma Okoye and Fabio Monzani*
Abstract Background: In late December 2019, a cluster of pneumonia cases due to a novel betacoronavirus, SARS-CoV-2 was reported in China. The so-called COVID 19 is responsible not only for respiratory symptoms, from mild up to pneumonia and even acute respiratory distress syndrome, but also for extrapulmonary involvement. Cases presentation: Here we present two cases of spontaneous muscle hematoma in patients with SARS-CoV-2 infection, both on therapeutic LMWH for atrial fibrillation: the first one was an 86-year-old Caucasian female with a history of hypertensive cardiomyopathy and the second one was an 81-year-old Caucasian male with a history of hypertension, diabetes and ischemic heart disease. Blood tests revealed a considerable drop of hemoglobin and alterations of coagulation system. In both cases, embolization of femoral artery was performed. A few other cases of bleeding manifestations are reported in literature, while a lot has been published about the hypercoagulability related to COVID-19. Conclusions: Our reports and literature review highlight the need of active surveillance for possible hemorrhagic complications in patients with SARS-CoV-2 infection. Keywords: COVID-19, Endothelial dysfunction, Vascular disease, Muscle haematoma, Case report
Background In late December 2019, a cluster of pneumonia cases of unknown etiology was reported in the city of Wuhan in Hubei Province, China. A novel betacoronavirus, SARSCoV-2, spread by inter-human transmission, is considered as the etiological agent of this disease [1, 2]. The World Health Organization (WHO) officially named the coronavirus disease “COVID-19” and declared a global pandemic in 2020. The spectrum of clinical manifestations of SARS-Cov-2 infection ranges from fever, fatigue, myalgia, cough and dyspnoea to pneumonia and even
acute respiratory distress syndrome. Extrapulmonary involvement, such as gastrointestinal (diarrhea, nausea/ vomiting, abdominal pain), cardiovascular (arrhythmias, myocardial injury) and renal (acute renal injury) have been reported as well. There is emerging evidence of the role of vascular disease in COVID-19 and clinical reports increasingly suggest a confluence of endothelial dysfunction, thrombosis and dysregulated inflammation [3]. Here we present two cases of older patients with SARSCov-2 infection, who presented spontaneous muscle hematoma on anticoagulation therapy with heparin in therapeutic dose.
* Correspondence: [email protected] † Sara Rogani and Valeria Calsolaro contributed equally as first author. Geriatrics Unit, Department of Clinical and Experimental Medicine, University of Pisa, Via Savi 10, 56126 Pisa, Italy © The Author(s). 2020 Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing,
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