Acute Limb Ischemia due to Arterial Thrombosis in a Patient with COVID-19 Pneumonia: A Case Report

Authors

  • Renata Primasari Clinical Pathology Specialization Program, Faculty of Medicine Universitas Airlangga, Surabaya, Indonesia
  • Yetti Hernaningsih Division of Hematology, Department of Clinical Pathology, Faculty of Medicine Universitas Airlangga - Dr. Soetomo Hospital, Surabaya, Indonesia http://orcid.org/0000-0001-8773-8267
  • Hartono Kahar Division of Hematology, Department of Clinical Pathology, Faculty of Medicine Universitas Airlangga - Dr. Soetomo Hospital, Surabaya, Indonesia
  • Bramantono Bramantono Division of Tropical and Infectious Diseases, Department of Internal Medicine, Faculty of Medicine Universitas Airlangga, Dr. Soetomo Hospital, Surabaya, Indonesia

Keywords:

acute limb ischemia, ALI, COVID-19, hypercoagulable state

Abstract

The COVID-19 pandemic has caused more than 4 million deaths worldwide to date. During the course of the COVID-19 pandemic, thrombotic complications due to hypercoagulable state have emerged as an important issue. Acute limb ischemia is one of emergency cases in vascular disease caused by a sudden decrease in arterial limbs perfusion. Here, we report a 53-year-old male patient with severe COVID-19 and a history of uncontrolled type 2 diabetes mellitus (T2DM) who developed extensive arterial thrombosis and limb ischemia despite being on therapeutic-dose anticoagulation, requiring surgical intervention. Right and left leg open thrombectomy was performed at day 7 after admission due to the excruciating pain and the worsening of the limb conditions. The patient was transferred to intensive care unit in emergency room because of the unstable hemodynamic and passed away a few hours after the surgery. For critically ill patients with COVID-19, special attention should be paid to abnormal coagulation dysfunction and microcirculatory disorders.

Author Biographies

Renata Primasari, Clinical Pathology Specialization Program, Faculty of Medicine Universitas Airlangga, Surabaya, Indonesia

Renata Primasari, MD, M.Biomed.Student of Clinical Pathology Specialization Program, Faculty of Medicine, Universitas Airlangga since 2020Graduated from the Faculty of Medicine, Universitas Brawijaya in 2017. Graduated as a Master of Biomedical Science from the Faculty of Medicine of Universitas Brawijaya in 2018.

Yetti Hernaningsih, Division of Hematology, Department of Clinical Pathology, Faculty of Medicine Universitas Airlangga - Dr. Soetomo Hospital, Surabaya, Indonesia

Yetti Hernaningsih, MD, Clinical Pathologist (Consultant of Hematology), Ph.DHead of Department of Clinical Pathology, Faculty of Medicine, Universitas Airlangga since 2016Graduated from the Faculty of Medicine, Universitas Airlangga in 1998. Graduated as a Clinical Pathologist from the Faculty of Medicine of Universitas Airlangga in 2004. Graduated in Doctoral Program in 2016 from Faculty of Medicine of Universitas Airlangga. Brevet as the consultant with the interest in hematology field from Faculty of Medicine, Universitas Airlangga in 2018.

Hartono Kahar, Division of Hematology, Department of Clinical Pathology, Faculty of Medicine Universitas Airlangga - Dr. Soetomo Hospital, Surabaya, Indonesia

Hartono Kahar, MD, Clinical Pathologist (Consultant of Hematology), Ph.D, MQIHGraduated from the Faculty of Medicine, Universitas Airlangga in 1986. Graduated as a Clinical Pathologist from the Faculty of Medicine of Universitas Airlangga in 1995. Graduated in Doctoral Program in 2012 from Faculty of Medicine of Universitas Airlangga.

Bramantono Bramantono, Division of Tropical and Infectious Diseases, Department of Internal Medicine, Faculty of Medicine Universitas Airlangga, Dr. Soetomo Hospital, Surabaya, Indonesia

Bramantono, MD, Internist (Consultant of Tropical and Infectious Disease)Graduated from the Faculty of Medicine, Universitas Airlangga in 1989. Graduated as an Internist from the Faculty of Medicine of Universitas Airlangga in 2005. Brevet as the consultant with the interest in tropical and infectious disease in 2013. 

References

John Hopkins University and Medicine. Johns Hopkins Coronavirus Resource Center - COVID-19 data in motion [Internet]. 2021. Available from: https://coronavirus.jhu.edu/covid-19-daily-video%0Ahttps://coronavirus.jhu.edu/

Levi M, Thachil J, Iba T, Levy JH. Coagulation abnormalities and thrombosis in patients with COVID-19. Lancet Haematol. 2020;7(6):e438–40.

Aboyans V, Ricco JB, Bartelink MLEL, et al. 2017 ESC guidelines on the diagnosis and treatment of peripheral arterial diseases, in collaboration with the European Society for Vascular Surgery (ESVS). Eur Heart J. 2018;39(9):763–816.

Nowroozpoor A, Bank MA, Jafari D. Limb ischemia due to extensive arterial thrombosis in the absence of venous occlusion as an unusual complication of critical illness from COVID-19. Case Reports Acute Med. 2021;4(1):23–31.

Dias LM, Martins J, Castro R, Mesquita A. Multiple arterial thrombosis in a patient with COVID-19. BMJ Case Rep. 2021;14(6):2–3.

McNally MM, Univers J. Acute limb ischemia. Surg Clin North Am. 2018;98(5):1081–96.

Yu HH, Qin C, Chen M, Wang W, Tian DS. D-dimer level is associated with the severity of COVID-19. Thromb Res [Internet]. 2020;195(April):219–25. Available from: https://doi.org/10.1016/j.thromres.2020.07.047

Zhou F, Yu T, Du R, et al. Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study. Lancet. 2020;395(10229):1054–62. Available from: http://dx.doi.org/10.1016/S0140-6736(20)30566-3

Zhou Y, Fu B, Zheng X, Wang D, Zhao C. Severe pulmonary syndrome patients of a new Coronavirus. bioRxiv Prepr. 2020;(February). Available from: https://doi.org/10.1101/2020.02.12.945576

Calvisi SL, Ramirez GA, Scavini M, et al. Thromboembolism risk is higher among patients with diabetes and COVID-19 and is associated to poor clinical outcome. medRxiv. 2021;2021.04.17.21255540. Available from: http://medrxiv.org/content/early/2021/04/20/2021.04.17.21255540.abstract

Kichloo A, Dettloff K, Aljadah M, et al. COVID-19 and hypercoagulability: A review. Clin Appl Thromb. 2020;26.

Olinic D-M, Stanek A, Tătaru D-A, Homorodean C, Olinic M. Acute limb ischemia: An update on diagnosis and management. J Clin Med. 2019;8(8):1215.

Björck M, Earnshaw JJ, Acosta S, et al. Editor’s choice – European Society for Vascular Surgery (ESVS) 2020 Clinical practice guidelines on the management of acute limb ischaemia. Eur J Vasc Endovasc Surg. 2020;59(2):173–218. Available from: https://doi.org/10.1016/j.ejvs.2019.09.006

Lind B, Morcos O, Ferral H, et al. Endovascular strategies in the management of acute limb ischemia. Vasc Spec Int. 2019;35(1):4–9.

Wang J, Chen K, Li X, et al. Postoperative adverse events in patients with diabetes undergoing orthopedic and general surgery. Med (United States). 2019;98(14):1–7.

Pozzobon FM, Perazzo H, Bozza FA, Rodrigues RS, de Mello Perez R, Chindamo MC. Liver injury predicts overall mortality in severe COVID-19: a prospective multicenter study in Brazil. Hepatol Int. 2021;15(2):493–501. Available from: https://doi.org/10.1007/s12072-021-10141-6

Taramasso L, Vena A, Bovis F, et al. Higher mortality and intensive care unit admissions in COVID-19 patients with liver enzyme elevations. Microorganisms. 2020;8(12):1–12.

Boregowda U, Aloysius MM, Perisetti A, Gajendran M, Bansal P, Goyal H. Serum activity of liver enzymes is associated with higher mortality in COVID-19: A systematic review and meta-analysis. Front Med. 2020;7(July):1–10.

Wang T, Fontenot RD, Soni MG, Bucci TJ, Mehendale HM. Enhanced hepatotoxicity and toxic outcome of thioacetamide in streptozotocin-induced diabetic rats. Toxicol Appl Pharmacol. 2000;166(2):92–100.

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Published

2022-09-24

How to Cite

Primasari, R., Hernaningsih, Y., Kahar, H., & Bramantono, B. (2022). Acute Limb Ischemia due to Arterial Thrombosis in a Patient with COVID-19 Pneumonia: A Case Report. Acta Medica Indonesiana, 54(3), 438. Retrieved from https://actamedindones.org/index.php/ijim/article/view/1937

Issue

Vol. 54 No. 3 (2022): Acta Medica Indonesiana

Section

CASE REPORT

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