In a new study, researchers describe how thrombosis (blood clots in the circulatory system) was an early indication of infection in a COVID-19 patient.
The paper details how a 67-year-old man, who had no previous medical history, came to the hospital with severe discoloring in his right arm and pain in his hand and forearm.
Further tests showed he had clots in arteries of his arm, generating ischemia (loss of blood flow) that threatened the limb. He soon tested positive for coronavirus.
The research was conducted by vascular surgeons at the University of Miami.
In the study, the team surgically revascularized the vessels in the patient. This was the first time UM vascular surgeons had used the negative pressure surgical suite, which helps prevent viral spread, on a confirmed COVID-positive patient.
However, surgery was just the beginning. Though the patient was not having much trouble breathing, his lungs were in bad shape.
First seen in April, this patient was an early indication to UM doctors that arterial thrombosis can be the presenting symptoms for coronavirus.
Other medical groups around the world have made similar observations, though nobody has yet identified precisely how the virus causes these sometimes-deadly blood clots.
Many laboratories are currently looking for this mechanism.
On autopsy studies in patients who died from coronavirus, doctors have found the virus causes micro-thrombosis, particularly in capillaries of the alveoli (tiny air sacs in the lungs).
However, the blockages described in this study were found in a medium-sized artery.
Though the surgery saved the patient’s arm and most of his hand, the coronavirus was not done, and he ended up spending weeks on a ventilator before finally being released from the hospital.
The team published this case to educate people who see coronavirus purely as a respiratory disease.
In particular, clinicians must be alert for COVID-19 infections when patients present with acute limb ischemia and no risk factors.
One author of the study is Tony Shao, M.D., an assistant professor of surgery.
The study is published in the Journal of Vascular Surgery.
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