Happy hypoxic: Unaware young man with DVTs and pulmonary emboli

Abstract

Introduction: COVID-19 is a multi-systemic disease announced to be a pandemic by the WHO within three months of the first reported case. It was initially characterized as a respiratory virus; however, hypercoagulability and development of strokes and deep vein thrombosis (DVTs) have been seen. We present a case of a young patient with no past medical history who developed minimally symptomatic bilateral DVTs and pulmonary emboli (PE). Case Report: A 26-year-old male with no past medical history presented with complaints of cough, fever, and diarrhea. Symptoms started two weeks prior to presentation, and he tested negative on COVID-19 nasal swab within that time frame. His cough was improving; however, he developed inability to keep food down along with bilateral calf pain with ambulation for three days prior to admission. Admission vitals were notable for fever and oxygen saturation of 91% on room air. A duplex ultrasound of the lower extremities showed bilateral thrombosis. Pulmonary computed tomography angiography (CTA) showed bilateral pulmonary emboli with numerous filling defects in the pulmonary arteries, along with peripheral interstitial densities. His COVID-19 nasal swab polymerase chain reaction (PCR) was negative, but the IgG serum antibody was positive. He was treated with steroids and anticoagulation. Conclusion: Studies have documented that patients with COVID-19 pneumonia have increased risk of lower limb DVT, despite proper prophylactic treatment. Clinicians must maintain high index of suspicion and a low threshold to order key tests in setting of unexplained hypoxia. We recommend obtaining serologic studies in late presenting patients with negative PCR swabs.