Jornal Vascular Brasileiro
https://jvascbras.org/article/doi/10.1590/1677-5449.202301752
Jornal Vascular Brasileiro
Case Report

Catastrophic thrombotic events with partial bilateral amputation of legs and fingers in a 12-year-old girl with COVID-19 in Brazil: case report

Eventos trombóticos catastróficos com amputação parcial bilateral de pernas e quirodáctilos em uma paciente de 12 anos com COVID-19 no Brasil: relato de caso

Giselly Rosa Modesto Pereira; André Ricardo Araújo da Silva; Claudia Escórcio Gurgel do Amaral Pitanga; Jocemir Ronaldo Lugon

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Abstract

The first case of COVID-19 was detected in Dec 2019, in China. The disease shortly evolved into a pandemic and imposed an unparalleled health and social burden on mankind. Severe forms of COVID-19 mainly affect adults, especially the elderly and those with comorbidities. We report a severe case of COVID-19 in a previously healthy 12-year-old female who was admitted to the emergency room on May 26, 2020, with fever, abdominal pain, vomiting, and diarrhea. During the hospital stay, she tested positive for SARS-CoV-2 and developed multiple organ failure and catastrophic thrombotic events resulting in bilateral amputation of legs and fingers. She was discharged from the hospital for outpatient follow-up after 107 days. By the time this report was written, the patient was undergoing prosthesis prescription and training and regaining her independence to walk.

Keywords

case report; SARS-CoV-2; COVID-19; children; thrombosis; amputation

Resumo

O primeiro caso de covid-19 foi detectado em dezembro de 2019, na China. A doença rapidamente evoluiu para uma pandemia e trouxe um fardo social e de saúde sem paralelo para a humanidade. As formas graves de covid-19 afetam principalmente adultos, especialmente idosos com comorbidades. Relatamos um caso grave de covid-19 em uma paciente de 12 anos de idade, previamente saudável, que deu entrada no pronto-socorro em 26/05/2020 com febre, dores abdominais, vômitos e diarreia. Durante a investigação, apresentou teste positivo para SARS-CoV-2 e evoluiu com falência múltipla de órgãos e eventos trombóticos catastróficos, resultando em amputação bilateral de pernas e quirodáctilos. Ela recebeu alta hospitalar para acompanhamento ambulatorial após 107 dias. No momento da redação deste relato, a paciente estava sendo submetida a protetização e recuperando marcha independente.

Palavras-chave

relato de caso; SARS-CoV-2; COVID-19; criança; trombose; amputação

References

1 Duong BV, Larpruenrudee P, Fang T, et al. Is the SARS CoV-2 omicron variant deadlier and more transmissible than delta variant? Int J Environ Res Public Health. 2022;19(8):4586. http://doi.org/10.3390/ijerph19084586. PMid:35457468.

2 Worldometer. COVID: coronavirus statistics [Internet]. 2023 [cited 2023 Apr 4]. https://www.worldometers.info/coronavirus

3 Zhou F, Yu T, Du R, et al. Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study. Lancet. 2020;395(10229):1054-62. http://doi.org/10.1016/S0140-6736(20)30566-3. PMid:32171076.

4 Howard-Jones AR, Burgner DP, Crawford NW, et al. COVID-19 in children. II: pathogenesis, disease spectrum and management. J Paediatr Child Health. 2022;58(1):46-53. http://doi.org/10.1111/jpc.15811. PMid:34694037.

5 Gagnier JJ, Kienle G, Altman DG, Moher D, Sox H, Riley D. The CARE guidelines: consensus-based clinical case reporting guideline development [Internet]. Oxford: The CARE Group; 2023 [cited 2023 Apr 4]. https://www.equator-network.org/reporting-guidelines/care/

6 Halushka MK, Vander Heide RS. Myocarditis is rare in COVID-19 autopsies: cardiovascular findings across 277 postmortem examinations. Cardiovasc Pathol. 2021;50:107300. http://doi.org/10.1016/j.carpath.2020.107300. PMid:33132119.

7 Lala A, Johnson KW, Januzzi JL, et al. Prevalence and impact of myocardial injury in patients hospitalized with COVID-19 infection. J Am Coll Cardiol. 2020;76(5):533-46. http://doi.org/10.1016/j.jacc.2020.06.007. PMid:32517963.

8 Verity R, Okell LC, Dorigatti I, et al. Estimates of the severity of coronavirus disease 2019: a model-based analysis. Lancet Infect Dis. 2020;20(6):669-77. http://doi.org/10.1016/S1473-3099(20)30243-7. PMid:32240634.

9 Chang R, Elhusseiny KM, Yeh YC, Sun WZ. COVID-19 ICU and mechanical ventilation patient characteristics and outcomes-a systematic review and meta-analysis. PLoS One. 2021;16(2):e0246318. http://doi.org/10.1371/journal.pone.0246318. PMid:33571301.

10 Kolhe NV, Fluck RJ, Selby NM, Taal MW. Acute kidney injury associated with COVID-19: a retrospective cohort study. PLoS Med. 2020;17(10):e1003406. http://doi.org/10.1371/journal.pmed.1003406. PMid:33125416.

11 Ronco C, Reis T. Kidney involvement in COVID-19 and rationale for extracorporeal therapies. Nat Rev Nephrol. 2020;16(6):308-10. http://doi.org/10.1038/s41581-020-0284-7. PMid:32273593.

12 Rastogi A, Dogra H, Jude EB. COVID-19 and peripheral arterial complications in people with diabetes and hypertension: a systematic review. Diabetes Metab Syndr. 2021;15(5):102204. http://doi.org/10.1016/j.dsx.2021.102204. PMid:34303918.

13 Amonkar PS, Gavhane JB, Kharche SN, Kadam SS, Bhusare DB. Aortic thrombosis in a neonate with COVID-19-related fetal inflammatory response syndrome requiring amputation of the leg: a case report. Paediatr Int Child Health. 2021;41(3):211-6. http://doi.org/10.1080/20469047.2021.1968596. PMid:34488566.

14 Delshad M, Safaroghli-Azar A, Pourbagheri-Sigaroodi A, Poopak B, Shokouhi S, Bashash D. Platelets in the perspective of COVID-19; pathophysiology of thrombocytopenia and its implication as prognostic and therapeutic opportunity. Int Immunopharmacol. 2021;99:107995. http://doi.org/10.1016/j.intimp.2021.107995. PMid:34304001.

15 Ravi S, Khadka S, Raghu CS, et al. COVID-19 presenting with a challenging combination of thrombocytopenia and thrombosis. J Med Cases. 2022;13(4):168-71. http://doi.org/10.14740/jmc3886. PMid:35464331.

16 Xu P, Zhou Q, Xu J. Mechanism of thrombocytopenia in COVID-19 patients. Ann Hematol. 2020;99(6):1205-8. http://doi.org/10.1007/s00277-020-04019-0. PMid:32296910.

17 Rossi FH. Venous thromboembolism in COVID-19 patients. J Vasc Bras. 2020;19:e20200107. http://doi.org/10.1590/1677-5449.200107. PMid:34211527.

18 Cuker A, Tseng EK, Schünemann HJ, et al. American Society of Hematology living guidelines on the use of anticoagulation for thromboprophylaxis for patients with COVID-19: March 2022 update on the use of anticoagulation in critically ill patients. Blood Adv. 2022;6(17):4975-82. http://doi.org/10.1182/bloodadvances.2022007940. PMid:35748885.

19 Soare C, Nowak VA, Osborne S. Eye care in the intensive care unit during the COVID-19 pandemic and beyond. Anaesthesia. 2020;75(8):1118-9. http://doi.org/10.1111/anae.15154. PMid:32519360.
 


Submitted date:
01/25/2024

Accepted date:
04/06/2024

Sociedade Brasileira de Angiologia e Cirurgia Vascular (SBACV)"> Sociedade Brasileira de Angiologia e Cirurgia Vascular (SBACV)">
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