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Retroperitoneal hemorrhage in a patient with coronavirus disease 2019 (COVID-19):A case report
Takuya Yoshioka1, Kei Daizumoto1, Kouki Tada1
1Department of Urology, Tokushima University Graduate School of Biomedical Sciences, Tokushima, Tokushima, Japan.
Insights
Early anticoagulation for coronavirus disease 2019 (COVID-19) can lead to retroperitoneal hemorrhage. This case highlights the need for careful treatment decisions in managing this serious complication.
Area of Science:
- Internal Medicine
- Critical Care Medicine
- Hematology
Background:
- Prophylactic anticoagulation is standard for coronavirus disease 2019 (COVID-19) patients.
- Retroperitoneal hemorrhage is a rare but serious complication.
Observation:
- A 69-year-old male COVID-19 patient developed retroperitoneal hemorrhage during heparin therapy.
- Clinical deterioration included drops in hemoglobin and blood pressure.
Findings:
- Computed tomography revealed a large retroperitoneal hematoma and iliopsoas muscle extravasation.
- Treatment involved stopping anticoagulation and initiating blood transfusions.
Implications:
- Management decisions for retroperitoneal hemorrhage in COVID-19 patients require careful consideration of the patient's overall condition.
- Treatment options include conservative management or transcatheter arterial embolization.
Introduction:
Early prophylactic administration of anticoagulants is recommended in patients with coronavirus disease 2019 (COVID-19). A case of retroperitoneal hemorrhage during inpatient treatment for COVID-19 is reported.
Case Presentation:
A 69-year-old man was diagnosed with COVID-19 6 days after symptom onset. After admission for difficulty of breathing, he was treated with steroid pulse therapy, remdesivir, and heparin sodium. On day 16 after admission, his hemoglobin and blood pressure dropped. Computed tomography showed a left retroperitoneal hematoma and multiple areas of extravasation in bilateral iliopsoas muscles. Anticoagulation therapy was stopped, and blood transfusion therapy was chosen by considering poor general condition caused by severe pneumonia. On day 19, the hemoglobin and blood pressure improved, and blood transfusion was stopped. However, he died on day 25 due to pneumonia.
Conclusion:
When retroperitoneal hemorrhage occurs as a complication of COVID-19, appropriate treatment decision, transcatheter arterial embolization or conservative treatment, should be chosen based on patient's condition. J. Med. Invest. 69 : 148-151, February, 2022.
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