Splenic Rupture in a COVID-19 Patient – A Case Report

Authors

  • Anna C. Crowley BS, Medical student, Alabama College of Osteopathic Medicine, Dothan, AL, United States
  • Raul R. Magadia MD, Northeast Alabama Regional Medical Center, Infectious Disease, United States
  • Arianna B. Lanpher BA, Medical student, Alabama College of Osteopathic Medicine, Dothan, AL, United States

DOI:

https://doi.org/10.5195/ijms.2021.912

Keywords:

Infectious Disease, COVID-19, Splenic Rupture, case report

Abstract

Background: It is well known that the Coronavirus disease 2019 (COVID-19) causes coagulation changes, requiring frequent monitoring for potential sequelae such as myocardial infarction and stroke. Non-traumatic splenic rupture is a rare and poorly understood occurrence in the clinical setting. Possible causes of nontraumatic splenic rupture include neoplasm, infection, inflammatory disease, iatrogenic and mechanical causes. Furthermore, increased intrasplenic tension, increased abdominal pressure, and thrombotic vascular occlusion are possible mechanisms.

The Case: We report a case of splenic rupture in a COVID-19 patient. Our patient was a 52-year-old black man, presenting with diarrhea and moderate dyspnea, who was found to be COVID-19 positive. He had a past medical history significant for end-stage renal disease, chronic anemia, and aortic valve replacement. In an otherwise uneventful, 7-day hospital course, the patient’s stay abruptly resulted in a nontraumatic splenic rupture and demise. In this report, we have evaluated the likelihood of COVID-19 causing splenic rupture in a patient with no prior splenic disease.

Conclusion: This case highlights the possibility of splenic rupture in otherwise normally recovering COVID-19 patients, particularly in the presence of comorbid conditions of renal failure and anticoagulation, with increased abdominal pressure during routine defecation. This information may assist in furthering the pathophysiology of COVID-19 and its life-threatening complications. In patients with COVID-19, non-traumatic splenic rupture should be considered as one of the differential diagnoses in patients who present with abdominal pain and early recognition of the same, owing to a high index of suspicion, can be lifesaving.

References

Temgoua MN, Endomba FT, Nkeck JR, Kenfack GU, Tochie JN, Essouma M. Coronavirus Disease 2019 (COVID-19) as a Multi-Systemic Disease and its Impact in Low- and Middle-Income Countries (LMICs). SN Compr Clin Med. 2020;1-11.

Kelsey Gockman, Alyssa Harbaugh, Yogendra Kanthi, Jason S. Knight, Daniel A. Lawrence, Jacqueline A. Madison, et al. Plasma tissue plasminogen activator and plasminogen activator inhibitor-1 in hospitalized COVID-19 patients. Scientific Reports. 2021 Jan;11:1580.

D. Candinas, B. Gloor, A Hostettler, P. Renzulli, A. M. Schoepfer. Systematic Review of Atraumatic Splenic Rupture. Br J Surg. 2009 Oct;96(10):1114-21. doi: 10.1002/bjs.6737.

Ayfer Aktas, Mustafa Aldemir, Ercan Gedik, Sadullah Girgin, Mustafa Aldemir, Celalettin Keles, Mehmet Cudi Tuncer. Non-Traumatic Splenic Rupture: Report of Seven Cases and Review of the Literature. World Journal of Gastroenterology. 2008 Nov; 14(43):6711–6.

Chikashi Gotoh, Kouji Masumoto, Kentara Ono, Toko Shinkai, Yasuhisa Urita. A Rare Mechanism of Delayed Splenic Rupture Following the Nonoperative Management of Blunt Splenic Injury in a Child. Surgical Case Reports. 2018 Dec; 4:75.

M. M. Al-Hawary, S. Azar, R. K. Kaza, I.R. Francis. Primary and Seconday Neoplasms of the Spleen. 2010 Aug; 10(1):173–82.

Se-Ho Chang, Hyun-Jung Kim, Gyeong-Won Lee, Jong Deog Lee, Dong Jun Park. Spontaneous Splenic Rupture in a Hemodialysis Patient. Yonsei Medical Journal, Yonsei University College of Medicine. 2005 Jun 30; 46(3):435–8.

Shaukat I, Khan R, Diwakar L, Kemp T, Bodasing N. Atraumatic splenic rupture due to covid-19 infection. Clinical infection in practice. 2021 Apr 1;10:100042.

Ronghui Du, Guohui Fan, Ying Liu, Zhibo Liu, Ting Yu, Fei Zhou, et al. Clinical Course and Risk Factors for Mortality of Adult Inpatients with COVID-19 in Wuhan, China: a Retrospective Cohort Study. The Lancet. 2020 Mar; 395(10229):1054-62.

David Berlin, Joanna Harp, Jeffrey Laurence, Cynthia Magro, J. Justin Mulvey, Steven Salvatore, et al. Complement Associated Microvascular Injury and Thrombosis in the Pathogenesis of Severe COVID-19 Infection: A Report of Five Cases. Translational Research: The Journal of Laboratory and Clinical Medicine. 2020 Jun; 220: 1–13.

Mobayen, M., Yousefi, S., Mousavi, M., & Anbaran, A. S. (2020). The presentation of spontaneous splenic rupture in a COVID-19 patient: a case report. BMC surgery, 20(1):1-5.

Judith A. James, Doruk Erkan, Joan T. Merrill, Jerald Winakur. Emerging Evidence of a COVID-19 Thrombotic Syndrome Has Treatment Implications. Nature Reviews Rheumatology. 2020 July; 16:581-9.

Published

2021-07-16

How to Cite

Crowley, A. C., Magadia, R. R., & Lanpher, A. B. (2021). Splenic Rupture in a COVID-19 Patient – A Case Report. International Journal of Medical Students, 9(3), 219–222. https://doi.org/10.5195/ijms.2021.912

Issue

Section

Case Report

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