Purpose The association between COVID-19 and hypercoagulability is well known. We present a lupus patient with unilateral renal vein thrombosis after COVID-19, the only known case described in the international literature so far.
Methods A 54-year-old female with a prior history of hypertension and systemic lupus erythematosus for 12 years and renal involvement (lupus podocytopathy by histopathology), on cyclosporine and low dose methylprednisolone, presented with back pain expanding in the left abdomen during the past 3 days and low-grade fever for the past few hours. Six months ago she had been vaccinated against Sars-Cov-2 (BioNTech, Pfizer), while a month prior to presentation she experienced COVID-19 with no need for hospitalization. The workup revealed increased inflammatory markers, while the abdominal CT scan/angiography established the diagnosis of acute thrombosis of the left renal and ovarian vein.
Results The patient was treated with anticoagulant therapy with consequent progressive clinical improvement. Co-existence of nephrotic syndrome, malignancy, secondary antiphospholipid syndrome, thrombophilia and myeloproliferative disease were ruled out with appropriate investigations according to the workup for visceral thrombosis. Therefore, the association of thrombosis with the recent COVID-19 disease was considered more likely. During the follow up the patient had complete resolution of symptoms while renal vein re-tunneling was documented on subsequent screening.
Conclusions Review of the literature in Pubmed revealed 12 reported cases of renal artery thrombosis in patients with COVID-19, but none with renal vein thrombosis as presented above. The present case adds another piece to the data of possible COVID-19 thrombosis, with excellent outcome due to early diagnosis and immediate initiation of treatment.
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