Bilateral pulmonary thromboembolism as the initial presentation of SARS-CoV-2 infection

BACKGROUND: SARS-CoV-2 infection can be associated with a hypercoagulable condition, which increases the prevalence of thromboembolic processes and the risk of deep vein thrombosis and pulmonary thromboembolism. CLINICAL CASE: An 82-year-old hypertensive woman admitted to the emergency department due to arthromyalgia, severe asthenia and cough, associated with minimal dyspnea on moderate efforts and an increase in the perimeter of the lower right limb of 3 days of evolution. Upon arrival at the emergency department, she presented tachycardia and tachypnea at rest. In the emergency department blood test showed a D-dimer elevation of 21,131 ng/mL. The chest X-ray showed patchy lung opacities, which was consistent with COVID-19. The CT angiography of the pulmonary arteries showed findings of bilateral pulmonary thromboembolism and COVID-19 pneumonia. A second PCR was positive for SARS-CoV-2. The patient was hospitalized for 8 days and showed improvement with the use of anticoagulant treatment, so it was decided to discharge her with home isolation. CONCLUSIONS: Recently, cases of thromboembolism are being described in patients with coronavirus infection, but pulmonary thromboembolism occurred when patient was admitted to the intensive care unit or in prolonged stays, unlike our patient who initially presented bilateral pulmonary thromboembolism, which is rare. Other cases of postpartum pulmonary embolism and after hospitalization associated with COVID-19 have been described. Therefore, in a patient with COVID-19, special attention must be paid to thromboembolic complications.