Spontaneous muscle hematoma in older patients with COVID-19: two case reports and literature review.

BACKGROUND: In late December 2019, a cluster of pneumonia cases due to a novel betacoronavirus, SARS-CoV-2 was reported in China. The so-called COVID 19 is responsible not only for respiratory symptoms, from mild up to pneumonia and even acute respiratory distress syndrome, but also for extrapulmonary involvement. CASES PRESENTATION: Here we present two cases of spontaneous muscle hematoma in patients with SARS-CoV-2 infection, both on therapeutic LMWH for atrial fibrillation: the first one was an 86-year-old Caucasian female with a history of hypertensive cardiomyopathy and the second one was an 81-year-old Caucasian male with a history of hypertension, diabetes and ischemic heart disease. Blood tests revealed a considerable drop of hemoglobin and alterations of coagulation system. In both cases, embolization of femoral artery was performed. A few other cases of bleeding manifestations are reported in literature, while a lot has been published about the hypercoagulability related to COVID-19. CONCLUSIONS: Our reports and literature review highlight the need of active surveillance for possible hemorrhagic complications in patients with SARS-CoV-2 infection.

A case report of dengue haemorrhagic fever complicated with psoas haematoma requiring blood transfusion.

BACKGROUND: Dengue fever is a common infection with increasing numbers of patients affected. Muscle haematomas are a rare complication of dengue fever. In most cases haematomas resolve spontaneously. CASE PRESENTATION: We report a case of spontaneous psoas muscle haematoma, formed during the critical phase of dengue haemorrhagic fever. A 28-year-old gentleman presented with features of severe dengue and was admitted to the Dengue High Dependency Unit. He was treated with intravenous fluid therapy and supportive measures, and gradually improved initially. However, as the critical phase ended, he suddenly developed pain in the left groin and inguinal region and physical examination was normal. Ultrasound scan revealed a left psoas haematoma. As the patient deteriorated haemodynamically blood was transfused. He recovered without further complication and was discharged home. CONCLUSIONS: Dengue fever is a common tropical infection. Recognizing serious complications such as psoas haematoma presenting as simple complaints such as back pain and inguinal pain are important to prevent mortality.

Spontaneous widespread muscle hematoma complicated by pyomyositis in a case of dengue hemorrhagic fever: a case report from Nepal.

Introduction and importance: Most dengue infections are asymptomatic, and some of them develop haemorrhagic manifestations with or without shock. However, dengue can sometimes present with very rare complications like pyomyositis. Case presentation: A healthy 27-year-old male, presented with a 2-day fever, confirmed to be dengue through a positive non-structural protein 1 test. Despite initial symptomatic management, his condition worsened and he was hospitalized. Leucocyte and platelet counts dropped to the lowest value on the seventh day of illness, followed by the gradual development of chest pain, persistent fever, and severe limb pain. Radiographic evaluation revealed pleural effusion, and multiple intramuscular haematomas complicated by pyomyositis. Pleural effusion resolved on its own. Pyomyositis resolved with 6 weeks of appropriate antibiotics and aspiration of pus. Clinical discussion: Dengue infection, caused by a dengue virus transmitted through Aedes mosquitoes, is a significant public health concern in many parts of the world. Dengue haemorrhagic fever is a severe form of dengue infection characterized by vascular leakage, thrombocytopenia, and bleeding manifestations. Although musculoskeletal manifestations are common in dengue fever, the occurrence of multiple muscle haematomas and pyomyositis as complications of Dengue haemorrhagic fever is rare. Drainage or aspiration of pus combined with the antibiotics according to the pus culture and sensitivity report is the management strategy. Conclusion: Prolonged fever with severe musculoskeletal pain and focal tenderness on examination in a dengue patient, warrant radiographic testing (ultrasonography or MRI) considering the differentials of haematoma, myositis, or pyomyositis.

Spontaneous gastrocnemius muscle haematoma formation in a patient with alcoholic liver disease.

Advanced liver disease is associated with several haemostatic alterations which can lead to either thrombosis or bleeding complications. Spontaneous muscle haematomas although a rare complication of liver cirrhosis is increasingly being described in the literature and hyperfibrinolysis is an emerging plausible pathophysiological mechanism. We describe a patient who presented with a life threatening spontaneous haematoma in his gastrocnemius muscle that required treatment with antifibrinolytic therapy to control further bleeding.

Spontaneous calf haematoma in severe dengue.

We report a case of spontaneous calf muscle haematoma, formed during the recovery phase of dengue haemorrhagic fever, which, to the best of our knowledge, has never been encountered before. A 45-year-old man presented with features of severe dengue and got admitted to our intensive care unit. He was treated with intravenous fluid therapy and supportive measures, and gradually improved, initially. However, during the recovery phase, he suddenly developed painful left calf, which was found tender, hot and swollen on physical examination. Colour Doppler ultrasound revealed left calf haematoma. As the patient rapidly developed local compartmental syndrome, surgical evacuation of the haematoma followed by urgent fasciotomy was performed. He recovered without further complication and was discharged home. At follow-up after 2 months, he remained well.

Rectus Sheath Haematoma Secondary to Enoxaparin Injection- A Rare Case Report.

Rectus sheath haematoma is a well-documented condition with an elusive diagnosis. It is an uncommon complication of anti-coagulation therapy, which can have a mortality of upto 25%. The patient discussed here is a 40-year-old female who was on Inj. Enoxaparin, who developed severe abdominal pain and hypovolemia after three days of treatment. Ultrasonography and CT scan showed a large rectus sheath haematoma on the right side, which was crossing the midline towards the left side. Inj. Enoxaparin was stopped and the patient was posted for surgery. In surgery, all clots were evacuated and inferior epigastric vessels were ligated. Patient recovered well following surgery. Here, this report presents forward a case of rectus sheath haematoma secondary to enoxaparin injection, its presentation and its surgical management.

Spontaneous muscle haematomas: management of 10 cases.

This is a retrospective study about the treatment of spontaneous muscle haematomas (SMH) that are an uncommon disease that occurs especially in elderly patients with acquired coagulopathy. We report the management of 10 cases admitted to our Emergency Surgical Unit (ESU) between March 2011 and October 2012. For this analysis we have considered some parameters such as age, drug history, current symptoms, location of the haematoma, cause, and imaging examination. Our attention focused on: clinical presentation, differential diagnosis, diagnostic imaging techniques and treatments.