Multiple Arterial Thrombosis in a COVID Patient With No Known Comorbidities With Mild Elevation of D-Dimer

Abstract

Since the coronavirus (COVID-19) pandemic started, new challenges have emerged regarding the management of coronavirus-infected patients. One of the most known devastating complications associated with COVID-19 is hypercoagulability. This can lead to severe disability or even death, especially in critically ill patients with known chronic comorbidities such as hypertension (HTN) and diabetes. D-dimer and clinical condition are among the most important tools currently used by clinicians to guide therapy and anticoagulation prophylaxis. Here we present a case of a COVID-19-infected patient with no known comorbidities and mild elevation in initial D-dimer level who had a rapid deterioration ultimately leading to death within weeks of admission.

Keywords: arterial thrombosis; coronavirus; covid 19; d-dimer; hypercoagulability; limb ischemia; multiple arterial thrombosis; sars-cov-2; stroke.

Figure 1. (A) Computed tomography (CT) head with no contrast showing lucency with loss of gray-white differentiation along the right insular cortex and subinsular region compatible with an acute infarct. (B) CT angiogram of the head showing perfusion defect in the right insular cortex and right frontal lobe suggesting a completed core infarct.

Figure 2. Computed tomography (CT) angiogram of right upper extremity showing occlusion of the most distal aspect of the right brachial artery at the bifurcation with no significant flow seen in the radial and ulnar arteries of the forearm (A) and small thrombus in the right innominate artery (B).