A Unique Tale of COVID-19 Induced Concomitant Overt DIC and Acute Bi-lateral Pulmonary Embolism

Siddiqui, Saquib Navid; Jayasekhar, Roland; Tshering, Sonam; Jugjali, Ranjana; Shanmugavadivel, Devipangaj; Jawed, Asheer; Rahman, Mohammed Mostafizur

Severe Acute Respiratory Syndrome - CoronaVirus - 2 (SARS-COV-2), a novel coronavirus resulted in the beginning of a new chapter in human history. Initially originating as an epidemic respiratory illness in Wuhan, China, COVID-19 eventually spread to almost all countries of the world and has now been declared as a global pandemic disease by the WHO. With each passing day, our understanding of the patho-physiology of COVID-19 continues to evolve. A plethora of research has been conducted to explore the dynamics of various different clinical entities related to SARS COV-2 and in particular, COVID-19 associated coagulopathy. A large scale of patients have been reported to have developed pulmonary embolism without any other standard triggers or risk factors. This has led to widespread speculation that the COVID-19 virus by itself is an independent risk factor for VTE. In addition to the development of thromboembolic complications like pulmonary embolism, COVID-19 has also been reported to have triggered disseminated intravascular coagulation (DIC). At this instance, it is unclear to state if pulmonary embolism was induced by COVID-19 induced thrombosis or if it was precipitated as a result of coagulopathy secondary to DIC. In this case report, we describe a unique case of a COVID associated coagulopathy in a patient with confirmed pulmonary embolism along with an overt DIC. Following the diagnosis, the challenge faced by us was the appropriate treatment modality with regard to this unique situation. The patient was then treated with anticoagulants and steroids along with blood products. The patient markedly improved and was clinically stable on discharge.