Pulmonary thromboembolism in a young female patient due to the novel coronavirus infection


DOI: https://dx.doi.org/10.18565/therapy.2022.10.117-123

Larina V.N., Karpenko D.G., Serova E.N., Ryzhikh A.A., Tyazhelnikov A.A.

1) N.I. Pirogov Russian National Research Medical University of the Ministry of Healthcare of Russia, Moscow; 2) Consultative and Diagnostic Polyclinic No. 121 of the Department of Healthcare of Moscow
Abstract. Article presents a case of sudden PATE after COVID-19 in a 36-year-old female patient. The patient was admitted to the cardiology department with complaints of mixed dyspnea. She had suffered from COVID-19 about a month earlier and had syncope condition the same month. After admission to the hospital, the patient was diagnosed with bilateral polysegmental interstitial pneumonia, and three days later she was discharged for outpatient treatment. Having suffered episodes of loss of consciousness three times a few days after discharge, she went to the city hospital on her own. On examination, the condition is satisfactory, body temperature is 36,8 °C, SpO2 is 91%, blood pressure is 130/70 mm Hg, pulse is 80/min. Ultrasound of the veins of the lower extremities - no signs of thrombosis. According to MSCT angipulmonography data, two days after the appeal, the patient was diagnosed with thromboembolism of the pulmonary artery and its branches. This observation allows us to conclude that the high incidence of thromboembolism in COVID-19 requires clinical vigilance regarding this complication even among young people and consideration of the appointment of anticoagulants, regardless of the treatment conditions.
Keywords: shortness of breath, COVID-19, pulmonary thromboembolism, young age
Read entire article

Literature

1. Goshua G., Pine A.B., Meizlish M.L. et al. Endotheliopathy in COVID-19-associated coagulopathy: Evidence from a single-centre, cross-sectional study. Lancet Haematol. 2020; 7(8): e575–e582. https://dx.doi.org/10.1016/S2352-3026(20)30216-7.


2. Tang N., Li D., Wang X., Sun Z. Abnormal coagulation parameters are associated with poor prognosis in patients with novel coronavirus pneumonia. J Thromb Haemost. 2020; 18(4): 844–47. https://dx.doi.org/10.1111/jth.14768.


3. Временные методические рекомендации «Профилактика, диагностика и лечение новой коронавирусной инфекции (COVID-19)». Версия 15 (22.02.2022). Минздрав России. Доступ: https://static-0.minzdrav.gov.ru/system/attachments/attaches/000/059/392/original/BMP_COVID-19_V15.pdf (дата обращения – 01.12.2022). [Interim guidelines «Prevention, diagnosis and treatment of novel coronavirus infection (COVID-19)». Version 15 (02/22/2022). Ministry of Healthcare of Russia. URL: https://static-0.minzdrav.gov.ru/system/attachments/attaches/000/059/392/original/BMP_COVID-19_V15.pdf (date of access – 01.12.2022) (In Russ.)].


4. Konstantinides S.V., Barco S., Lankeit M., Meyer G. Management of pulmonary embolism: An update. J Am Coll Cardiol. 2016; 67(8): 976–90. https://dx.doi.org/10.1016/j.jacc.2015.11.061.


5. Becattini C., Kokorin V.A., Lesniak W. et al. Pulmonary embolism – An EFIM guideline critical appraisal and adaptation for practicing clinicians. Eur J Intern Med. 2022; 96: 5–12. https://dx.doi.org/10.1016/j.ejim.2021.12.001.


6. Magro C., Mulvey J.J., Berlin D. et al. Complement associated microvascular injury and thrombosis in the pathogenesis of severe COVID-19 infection: A report of five cases. Transl Res. 2020; 220: 1–13. https://dx.doi.org/10.1016/j.trsl.2020.04.007.


7. Varga Z., Flammer A.J., Steiger P. et al. Endothelial cell infection and endotheliitis in COVID-19. Lancet. 2020;395(10234): 1417–18. https://dx.doi.org/10.1016/S0140-6736(20)30937-5.


8. Ciceri F., Beretta L., Scandroglio A.M. et al. Microvascular COVID-19 lung vessels obstructive thromboinflammatory syndrome (MicroCLOTS): An atypical acute respiratory distress syndrome working hypothesis. Crit Care Resusc. 2020; 22(2): 95–97. Online ahead of print.


9. Кассина Д.В., Василенко И.А., Гурьев А.С. с соавт. Нейтрофильные внеклеточные ловушки: значение для диагностики и прогноза COVID-19. Альманах клинической медицины. 2020; 48(S1): 43–50. [Kassina D.V., Vasilenko I.A., Guriev A.S. et al. Neutrophil extracellular traps: diagnostic and prognostic value in COVID-19. Al’manakh klinicheskoy meditsiny = Almanac of Clinical Medicine. 2020; 48(S1): 43–50 (In Russ.)]. https://dx.doi.org/10.18786/2072-0505-2020-48-029. EDN: UOHMXR.


10. Papayannopoulos V. Neutrophil extracellular traps in immunity and disease. Nat Rev Immunol. 2018; 18(2): 134–47. https://dx.doi.org/10.1038/nri.2017.105.


11. Klok F.A., Kruip M.J.H.A., van der Meer N.J.M .et al. Incidence of thrombotic complications in critically ill ICU patients with COVID-19. Thromb Res. 2020; 191: 145–47. https://dx.doi.org/1016/j.thromres.2020.04.013.


12. Явелов И. С., Драпкина О. М. COVID-19: состояние системы гемостаза и особенности антитромботической терапии. Кардиоваскулярная терапия и профилактика. 2020; 19(3): 2571. [Yavelov I.S., Drapkina O.M. COVID-19: the state of the hemostasis system and features of antithrombotic therapy. Cardiovascular therapy and prevention. 2020; 19(3): 2571 (In Russ.)]. https://dx.doi.org/10.15829/1728-8800-2020-2571. EDN: DHVKSZ.


13. Шпилянский Э.М., Ройтман Е.В., Морозов К.М., Сухарева Т.В. Опыт лечения пациентов с артериальными и венозными тромбозами при COVID-19: клинические наблюдения. Комплексные проблемы сердечно-сосудистых заболеваний. 2021; 10(4): 131–141. [Shpilyanskiy E.M., Roitman E.V., Morozov K.M., Sukhareva T.V. Experience in the management of patients with arterial and venous thrombosis and COVID-19. Kompleksnyye problemy serdechno-sosudistykh zabolevaniy = Complex Issues of Cardiovascular Diseases. 2021; 10(4): 131–141 (In Russ.)]. https://dx.doi.org/10.17802/2306-1278-2021-10-4-131-141. EDN: CRRAFN.


14. Панченко Е.П., Балахонова Т.В., Данилов Н.М. с соавт. Диагностика и лечение тромбоэмболии легочной артерии: клинические рекомендации Евразийской ассоциации кардиологов для практических врачей (2021). Евразийский кардиологический журнал. 2021; 1: 44–77. [Panchenko E.P., Balakhonova T.V., Danilov N.M. et al. Diagnosis and treatment of pulmonary embolism: clinical guidelines of the Eurasian Association of Cardiology for practitioners (2021). Yevraziyskiy kardiologicheskiy zhurnal = Eurasian Journal of Cardiology. 2021; 1: 44–77 (In Russ.)]. https://dx.doi.org/10.38109/2225-1685-2021-1-44-77. EDN: FIZAJO.


About the Autors

Vera N. Larina, Dr. med. habil., professor of the Department of polyclinic therapy, faculty of medicine, N.I. Pirogov Russian National Research Medical University of the Ministry of Healthcare of Russia. Address: 117997, Moscow, 1/7 Ostrovityanova Str. E-mail: larinav@mail.ru. ORCID: https://orcid.org/0000-0001-7825-5597
Dmitry G. Karpenko, PhD in Medicine, associate professor of the Department of polyclinic therapy, faculty of medicine, N.I. Pirogov Russian National Research Medical University of the Ministry of Healthcare of Russia. Address: 117997, Moscow, 1/7 Ostrovityanova Str.
Elena N. Serova, PhD in Medicine, associate professor of the Department of polyclinic therapy, faculty of medicine, N.I. Pirogov Russian National Research Medical University of the Ministry of Healthcare of Russia. Address: 117997, Moscow, 1/7 Ostrovityanova Str.
Alina A. Ryzhykh, postgraduate student of the Department of polyclinic therapy, faculty of medicine, N.I. Pirogov Russian National Research Medical University of the Ministry of Healthcare of Russia. Address: 117997, Moscow, 1/7 Ostrovityanova Str.
Andrey A. Tyazhelnikov, PhD in Medicine, chief physician of Consultative and Diagnostic Polyclinic No. 121 of the Department of Healthcare of Moscow. Address: 117042, Moscow, 87 Yuzhnobutovskaya Str.


Similar Articles

Back to Content

Бионика Медиа