Splanchnic venous thrombosis in a nephrotic patient following COVID-19 infection: a case report

BMC Nephrology

Mohamad S. Alabdaljabar¹  Maged H. Hussein²  Khalid Alamiri²  Noorah Alfagyh²  Mohammad Badran³ 

[1] College of Medicine, Alfaisal University, Riyadh, Kingdom of Saudi Arabia;Department of Medicine, King Faisal Specialist Hospital and Research Center, P.O.Box 3354, MBC-46, 11211, Riyadh, Saudi Arabia;Department of Radiology, King Faisal Specialist Hospital and Research Center, Riyadh, Kingdom of Saudi Arabia;

关键词: SARS-CoV-2;    Nephrotic syndrome;    Splanchnic vein thrombosis;    Portal vein thrombosis;    Hypercoagulable state;   

DOI  :  10.1186/s12882-021-02643-0

来源: Springer

【 摘 要 】

BackgroundAs the COVID-19 pandemic spread worldwide, case reports and small series identified its association with an increasing number of medical conditions including a propensity for thrombotic complications. And since the nephrotic syndrome is also a thrombophilic state, its co-occurrence with the SARS-CoV-2 infection is likely to be associated with an even higher risk of thrombosis, particularly in the presence of known or unknown additional risk factors. Lower extremity deep vein thrombosis (DVT) and pulmonary embolism (PE) are the most common manifestations of COVID-19-associated hypercoagulable state with other venous or arterial sites being much less frequently involved. Although splanchnic vein thrombosis (SVT) has been reported to be 25 times less common than usual site venous thromboembolism (VTE) and rarely occurs in nephrotic patients, it can have catastrophic consequences. A small number of SVT cases have been reported in COVID-19 infected patients in spite of their number exceeding 180 million worldwide.Case presentationAn unvaccinated young adult male with steroid-dependent nephrotic syndrome (SDNS) who was in a complete nephrotic remission relapsed following contracting SARS-CoV-2 infection and developed abdominal pain and diarrhea. Abdominal US revealed portal vein thrombosis. The patient was anticoagulated, yet the SVT rapidly propagated to involve the spleno-mesenteric, intrahepatic and the right hepatic veins. In spite of mechanical thrombectomy, thrombolytics and anticoagulation, he developed mesenteric ischemia which progressed to gangrene leading to bowel resection and a complicated hospital course.ConclusionOur case highlights the potential for a catastrophic outcome when COVID-19 infection occurs in those with a concomitant hypercoagulable state and reminds us of the need for a careful assessment of abdominal symptoms in SARS-CoV-2 infected patients.

【 授权许可】

CC BY