Abstract
The coronavirus disease 2019 (COVID-19) disease is a multisystem disease and recent studies have shown an increase in reported thromboembolic complications as deep venous thrombosis, pulmonary embolism (PE), stroke, and less frequently mesenteric artery thrombosis. We present a case of a 75-year-old woman, COVID-19 positive with five days of evolution, who was admitted to the emergency room due to diffuse abdominal pain with several days of progression, along with diarrhea and biliary vomit. Abdominal computed tomography presented images of subtraction of the lumen of the upper mesenteric artery. With the reported clinical case the authors intend to clarify the importance of differential diagnosis in patients with a typical severe acute respiratory syndrome coronavirus 2 (SARS CoV2) infection presentation. The gastrointestinal symptoms of SARS CoV2 infection can mask a more severe condition, so a high index suspicion for abdominal thromboembolic events is required once this complication may threaten patient’s life.
Highlights
The coronavirus disease 2019 (COVID-19) has multiple forms of presentation
It is known that the membrane of the virus has a spike protein [3], which binds to the angiotensin-converting enzyme 2 (ACE2) receptor expressed in vascular endothelium
The binding of severe acute respiratory syndrome coronavirus 2 (SARS CoV 2) to ACE2 reduces the degradation of angiotensin II, and stimulates the production of interleukin 6, which induces the production of tissue factor and plasminogen activator inhibitor-1, leading to a hypercoagulable state [4]
Summary
The coronavirus disease 2019 (COVID-19) has multiple forms of presentation. It mainly affects the respiratory system, in the form of pneumonia, it can target almost every system, such as the gastrointestinal [1] and neurologic, and more recent studies have shown an increase in reported thromboembolic complications [2]. The binding of severe acute respiratory syndrome coronavirus 2 (SARS CoV 2) to ACE2 reduces the degradation of angiotensin II, and stimulates the production of interleukin 6, which induces the production of tissue factor and plasminogen activator inhibitor-1, leading to a hypercoagulable state [4]. Along with deep venous thrombosis, pulmonary embolism (PE), and stroke, acute mesenteric ischemia (AMI) has been reported in severe COVID-19 patients. Parameter Leucocytes Neutrophils Lymphocytes C-reactive protein Procalcitonin D-dimer Lactate Potassium Alanine transaminase (ALT) Aspartate transaminase (AST) Alkaline phosphatase (ALP) Gamma-glutamyl transpeptidase (GGT)
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