RESUMO
INTRODUCTION: Multiple studies suggest that SARS-CoV-2 infection is associated with a pro-thrombotic state and thrombotic events have been recorded in several organs and systems. We report a patient with no respiratory symptoms, presented with abdominal pain and an extensive splenic infarction after COVID-19. CASE REPORT: A 67 year-old man was admitted to the emergency department with a moderate, dull, left-sided abdominal pain. The patient denied respiratory symptoms but referred contact with family members positive for COVID-19. He tested positive for COVID-19 and had increased D-dimer levels. Imaging studies revealed splenic infarcts and ground-glass opacities in bilateral pulmonary bases. He was treated with full-dose anticoagulation and was discharged home on oral Rivaroxaban. DISCUSSION: Although rare in the literature, cases of acute abdomen in COVID-19 patients associated with vascular infarctions have increased. Coagulopathy may be present even without clinical respiratory manifestations of the disease. Patients meeting disseminated intravascular coagulation criteria or with markedly elevated D-dimer may benefit from anticoagulant therapy. CONCLUSION: Clinicians should suspect of abdominal visceral infarctions in COVID-19 patients presented with acute abdominal pain, despite the absence of respiratory symptoms.
RESUMO
Apresentamos um caso de um adolescente de 14 anos, atleta da categoria sub-15 de um clube de futebol do Brasil, com diagnóstico de fratura de fêmur distal Salter-Harris tipo II por um mecanismo de hiperextensão do membro inferior. Foi optado por tratamento conservador com uso de órtese para imobilização e muletas para deambulação. O acompanhamento foi feito com 7, 21, 56 e 86 dias de evolução com o auxílio de tomografia computadorizada, ressonância magnética e radiografia simples de joelho. O atleta não apresentou nenhum sintoma ou incapacidade após os 90 dias de acompanhamento, mas foi verificada uma epifisiodese no exame de imagem. Apesar de ser uma fratura da placa de crescimento femoral distal comum em adolescentes entre 11 e 14 anos de idade por trauma direto ou por angulação do fêmur distal por um pé fixo ao solo que é golpeado pelo lado por outro individuo, não há relatos de fratura Salter-Harris tipo II por mecanismo de hiperextensão do membro inferior na literatura
We report a case of a 14-year-old athlete in the U-15 category of a soccer club in Brazil with a diagnosis of Salter-Harris type II distal femur fracture due to a hyperextension mechanism of the lower limb. Conservative treatment with bracing and crutches for ambulation was used. Follow-up was performed with 7, 21, 56 and 86 days of evolution with the aid of computed tomography, magnetic resonance and simple knee radiography. The athlete did not present any symptoms or disability after the 90 days of follow-up, but an epiphysiodesis was verified in the image exam. Despite being a common distal femoral growth plate fracture in adolescents between 11 and 14 years-old due to direct trauma or distal femur angulation by a foot fixed to the ground that is struck by the side by another individual, there are no reports of fracture Salter-Harris type II by mechanism of hyperextension of the lower limb in the literature
