COVID-19 and Hepatic Artery Thrombosis: A Case Report

de Brito, Carlos Alexandre Antunes; de Oliveira Filho, José Ricardo Bandeira; Marques, Diogo Torres; Lencastre, Maria do Carmo; de Almeida, José Roberto; Lopes, Edmundo Pessoa

Patient: Female, 45-year-old Final Diagnosis: COVID-19 • hepatic artery thrombosis Symptoms: Abdominal pain • anosmia • asthenia • cough • dysgeusia • headache • myalgia • sore throat Medication: — Clinical Procedure: Anticoagulant Specialty: Gastroenterology and Hepatology • Infectious Diseases OBJECTIVE: Unusual clinical course BACKGROUND: Hypercoagulable states, including venous and arterial thromboses, manifesting as pulmonary thromboembolism or stroke have been observed in COVID-19; recently, gastrointestinal thrombotic events have also been reported. This case report describes a patient with COVID-19 and abdominal pain, who developed coagulopathy and a rare association of hepatic artery thrombosis. Common hepatic artery thrombosis is usually observed among liver transplantation patients and has not been described in infectious disease. CASE REPORT: A 45-year-old woman presented in the Emergency Department with a nonproductive cough, sore throat, asthenia, headache, myalgia, anosmia, and dysgeusia. On the 5(th) day after the onset of these symptoms, she tested positive for SARS-COV-2 and was managed with symptomatic drugs. Although her initial symptoms of COVID-19 improved progressively, on the 14(th) day she experienced acute abdominal pain. On the 16th day, she was hospitalized and administered intravenous analgesia. Abdominal computed tomography angiography revealed partial thrombosis in the common hepatic artery, which was confirmed by liver Doppler ultrasonography. Protein C and D-dimer levels peaked during this period. Serum tests for thrombophilia were negative. Subcutaneous enoxaparin (60 mg twice daily) was administered during hospitalization, and her abdominal pain improved significantly. She was discharged after 3 days and prescribed an oral anticoagulant for the next 30 days. CONCLUSIONS: Thrombotic events are well-recognized complications of COVID-19 and recent reports show gastrointestinal involvement. This report of a rare association of hepatic artery thrombosis highlights the importance of investigating the thrombotic events in patients with abdominal pain and coagulopathy during COVID-19.