Background The coronavirus disease (COVID-19) pandemic has led to an unprecedented worldwide burden of disease. However, little is known of the longer-term implications and consequences of COVID-19. One of these may be a COVID-19 associated coagulopathy that can present as a venous thromboembolism (VTE) and further, as multiple paradoxical cerebral emboli. Case presentation A 51 year old man presented to the emergency department with multiple simultaneous embolic cerebral infarctions 11 months after mild COVID-19. In the subacute phase of the COVID-19 illness the patient developed increasing shortness of breath and was found to have an elevated D-dimer and multiple bilateral segmental pulmonary emboli. He was subsequently treated with 3 months of anticoagulation for a provoked VTE. The patient then presented 11 months after the initial COVID-19 diagnosis with multiple simultaneous cerebral infarctions where no traditional underlying stroke etiology was determined. A patent foramen ovale (PFO) and an elevated D-dimer were found suggesting a paradoxical thromboembolic event due to an underlying coagulopathy. Conclusions This case report highlights the one of the potentially more serious complications of long-term COVID-19 where VTE due to a persistent coagulopathy is seen almost a year after the initial illness. Due to the highly prevalent nature of PFO in the general population, VTE due to COVID-19 associated coagulopathy could lead to ischemic stroke. This case report highlights the possibility for an underlying COVID-19 associated coagulopathy which may persist for many months and beyond the initial illness.
【저자키워드】 COVID-19, anticoagulation, stroke, Coagulopathy, Pulmonary embolus, Thrombolysis, 【초록키워드】 coronavirus disease, pandemic, D-dimer, Venous Thromboembolism, Case report, Patient, COVID-19 diagnosis, Mild, General population, etiology, disease, Infarction, VTE, Shortness of breath, Pulmonary emboli, emboli, COVID-19 illness, Thromboembolic event, implication, consequence, prevalent, highlight, serious complication, initial, the patient, elevated, treated, was determined, embolic, paradoxical, 【제목키워드】 Infarction, Multiple, embolic,