Abstract
Background: It is well known that Coronavirus disease 2019 (COVID-19) causes coagulation changes, requiring frequent monitoring for potential sequelae such as myocardial infarction and stroke. Non-traumatic splenic rupture is a rare and poorly understood occurrence in the clinical setting. Possible causes of nontraumatic splenic rupture include neoplasm, infection, inflammatory disease, iatrogenic and mechanical causes. Furthermore, increased intrasplenic tension, increased abdominal pressure, and thrombotic vascular occlusion are three possible mechanisms.
 The Case: We report a case of splenic rupture in a COVID-19 patient. Our patient was a 52 year old black man, presenting with diarrhea and moderate dyspnea, who was found to be COVID-19 positive. He had a past medical history significant for end-stage renal disease, chronic anemia, and aortic valve replacement. In an otherwise uneventful, 7-day hospital course, the patient’s stay abruptly resulted in a nontraumatic splenic rupture and demise. In this report, we have evaluated the likelihood of COVID-19 causing splenic rupture in a patient with no prior splenic disease.
 Conclusion: This case highlights the possibility of splenic rupture in otherwise normally recovering COVID-19 patients, particularly in the presence of comorbid conditions of renal failure and anticoagulation, with increased abdominal pressure during routine defecation. This information may assist in furthering the pathophysiology of COVID-19 and its life-threatening complications. In patients with COVID-19, non-traumatic splenic rupture should be considered as one of the differential diagnosis in patients who present with abdominal pain and early recognition of the same, owing to a high index of suspicion, can be lifesaving.
Highlights
While the Coronavirus disease 2019 (COVID-19) is known to present with significant pulmonary and cardiac manifestations, other systemic complications and interactions with pre-existing pathology are being recognized.[1]
We describe a case of nontraumatic splenic rupture in a COVID-19 patient being treated with anticoagulants and routine hemodialysis
We believe this case of non-traumatic splenic rupture in a COVID-19 patient was caused by interactions from COVID-19-related coagulation changes
Summary
While the Coronavirus disease 2019 (COVID-19) is known to present with significant pulmonary and cardiac manifestations, other systemic complications and interactions with pre-existing pathology are being recognized.[1]. Diagnostic dilemma of conflicting coagulation studies in a COVID-19 patient with chronic renal failure requiring hemodialysis and valve replacement requiring warfarin therapy, leading to splenic rupture, a complication that is associated with hypocoagulable state. Hospital Course: On the second day of admission, the patient received dialysis, and over the six days underwent a total of three hemodialysis treatments coupled with three separate packed RBC transfusions because of his severe anemia. His chest radiograph remained clear and diarrhea subsided by Day 2.
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