Acute portal vein thrombosis with COVID-19 and cirrhosis.

A 67-year-old Japanese man with diabetes, alcohol-related cirrhosis, and esophageal varices was transferred to our hospital with fever and respiratory distress. On admission, he was diagnosed with severe COVID-19 due to hypoxemia. He received nasal high-flow oxygen treatment (40 L/min), remdesivir, and dexamethasone. On hospital day (HD) 5, his D-dimer level was elevated to 7.3 μg/mL, but we did not administer anticoagulants because of his history of ruptured esophageal varices. On HD 12, contrast-enhanced CT showed portal vein thrombosis extending from the superior mesenteric vein to the main trunk of the portal vein (Fig. 1), which had not been detected on plain CT on the day of admission, and anticoagulation was initiated immediately.

Fig. 1

Acute portal vein thrombosis with severe COVID-19 and cirrhosis.

The contrast-enhanced computed tomography scan taken 12 days after admission to hospital shows acute portal vein thrombosis extending from the superior mesenteric vein to the main trunk of the portal vein (Panel A).

Patients with COVID-19 sometimes develop both arterial and venous thrombosis [1]. COVID-19 may also be associated with portal vein thrombosis [2,3]. Observational studies suggest that anticoagulation in COVID-19 patients with D-dimer levels >3.0 μg/mL may be associated with lower mortality rates [4]. However, the decision to start anticoagulants needs to be carefully considered in COVID-19 patients with a high bleeding risk, such as a history of ruptured esophageal varices, as in this case.

Funding source

This work was supported by the NCGM Intramural Research Fund [grant number 20A05].

Consent

Written informed consent was obtained from the patient for publication of this case report and accompanying images.

Ethical approval

Written informed consent was obtained from the patient for publication of this case report and accompanying images.

Author contribution

Conceptualization: Yusuke Miyazato, Masahiro Ishikane.

Data curation: Yusuke Miyazato, Masahiro Ishikane, Makoto Inada.

Formal analysis: Yusuke Miyazato, Masahiro Ishikane.

Supervision: Norio Ohmagari.

All authors contributed to the writing of the final manuscript.

Declaration of Competing Interest

The authors report no declarations of interest.