S3037 Unfortunate Complications of Acute Hemolytic Anemia, Gastric Pneumatosis With Superior Mesenteric Artery Occlusion, and Stroke Observed in a Patient With COVID-19

Abstract

INTRODUCTION: The coronavirus disease 2019 (COVID-19) has been an ongoing global threat and has required the medical community to be vigilant in finding complications associated with the virus. Our case study highlights severe complications seen in a critically ill patient due to the SARS-COV-2 virus who developed acute hemolytic anemia, gastric pneumatosis with SMA occlusion, and stroke. Further investigation is needed to identify a common pathway that could be causing a variety of these symptoms. CASE DESCRIPTION/METHODS: A 68 year old female with a known PMH of CVA, HTN, HLD, and DM presented to the hospital for evaluation of right-upper quadrant abdominal pain and flank pain. On physical examination, the patient was jaundiced with diffuse abdominal distention. A SARS COV- 2 PCR test was obtained for a patient having non-specific abdominal pain, which came back positive. Her initial lab values on admission presented concerns of hemolysis and the patient was started on prednisone 1mg/kg for cacute hemolytic anemia. On Hospital day 3, her oxygen requirements continued to decline and the patient was placed on remdemsivr therapy. A CT abdomen and pelvis showed a developing gastric pneumatosis within a portion of the dilated small bowel loops with an arterial occlusion involving the first 2.5cm of the superior mesenteric artery. Later that evening, the patient developed a new onset left facial droop and left sided hemiparesis. A stat CT and CT angiogram was negative for any large vessel occlusion. Stat labs depicted a hemoglobin drop to 5 g/dl. The patient received TPA given her new onset of symptoms and was transfused 2 units of packed red blood cells. The next day, a repeat CT scan of the head depicted concerns of LVO note seen on initial read. The patient was placed on comfort care measures as surgery would be futile and her intestines were extensively damaged. DISCUSSION: The SARS-COV-2 virus ability to cause such cytokine release and to have diffuse entry into the cells may be an explanation in diffuse tissue injury. Our case report highlights an important point that the virus can cause asymptomatic patients to progress into a rapid decline of overall health and has the ability to affect multi-organ systems. Further research and treatment options are required with SARS-COV2 to understand the pathophysiology behind the pro-inflammatory response seen in various organ systems due to the virus and treatment options.