Abstract
The increased risk for thromboembolism in hospitalized COVID-19 patients has been communicated extensively. The fact that home quarantined patients can develop pulmonary embolism, however, has so far not been reported. Furthermore, attention should be brought to psychotic developments in COVID-19 patients. We report a 46-year-old previously healthy patient with a mild course of COVID-19, who developed a massive pulmonary embolism with right heart strain while being home quarantined. He was hospitalized and anticoagulant therapy was started. Nine days after admission, the patient appeared increasingly psychotic and suffered from hallucinations as well as paranoid thoughts. After treatment with risperidone and valproate, the patient’s condition improved. At a follow-up 1 month after discharge, he was completely recovered regarding the respiratory, cardiac, and psychic situation. SARS-CoV-2 infection can not only increase the prevalence of thromboembolism in hospitalized patients but also in outpatients. COVID-19 also increases the risk of developing psychiatric reactions.
Highlights
A high rate of venous thromboembolism has been reported in patients with COVID-19
Venous thromboembolism can occur in nonhospitalized patients with mild cases of COVID-19, may even lead to sudden cardiac death, and may only be detected during autopsy [11, 12]
In a prospective autopsy study among 12 COVID-19 patients, one third has died from pulmonary embolism and deep venous thrombosis was found in 58% [12]
Summary
A high rate of venous thromboembolism has been reported in patients with COVID-19. prophylaxis for venous thromboembolism is recommended during and after hospital admission for these patients [1]. The patient was discharged 12 days after the initial hospital admission to complete his quarantine at home. An adaption disorder with anxiety was diagnosed and on the second day, he was transferred to a psychiatric department, where he was found having optical and auditive hallucinations and was talking to nonexisting people. He suffered from paranoiac thoughts and was convinced that metallic parts were implanted in his body. After two negative SARS-CoV-2 nasooropharyngeal swabs, the patient was discharged 3 days later with valproate 500 mg twice daily and risperidone 1 mg twice daily, as well as edoxaban 60 mg once daily.
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