Bilateral acute cardioembolic limb ischemia after Covid-19 pneumonia in a lung transplant recipient: a case report

Renaud-Picard, Benjamin; Gallais, Floriane; Ohana, Mickael; Zeyons, Floriane; Kretz, Benjamin; Andre, Jocelyn; Sattler, Laurent; Hirschi, Sandrine; Kessler, Romain

ABSTRACT Very few cases of lung transplant patients affected by Covid-19 have been reported to date. A 31-year-old patient with bilateral lung transplantation for cystic fibrosis in 2012 was admitted for severe acute lower limb pain. He had a confirmed exposure to Covid-19, and a 3-week history of upper respiratory tract infection. Whole body computed tomography (CT) angiography revealed an occlusion of the two common femoral arteries. CT angiography detected an intracardiac thrombus in the left ventricle. Chest CT angiography showed ground-glass opacities consistent with a Covid-19. A bilateral femoral surgical embolectomy using Fogarty probe was successfully performed. Specific RT-PCR for SARS-CoV-2 performed on an extracted thrombus was negative but IgM antibodies specific to Covid-19 were detected. Cardiac MRI demonstrated a sub-endocardial and almost transmural late gadolinium enhancement in the mid and distal inferolateral and inferior wall segments, consistent with a non-recent myocardial infarction and an apical centimetric thrombus adjacent to the lesion. Thrombophilia laboratory tests found the presence of a positive lupus anticoagulant.Treatment with low-molecular weight heparin and aspirin was prescribed. On day 13, patient was discharged from hospital. This case underlines the need to be vigilant with respect to the thrombotic complications of Covid-19 and raises the issue of thrombosis prevention in Covid-19 patients.