A female patient in her late forties presented to the emergency department with neck swelling and pain on the right side for the last week. She had a significant past medical history of noninsulin-dependent diabetes mellitus, hypertension, morbid obesity, and iron deficiency anemia. The patient had a right internal jugular (IJ) tunneled catheter for iron infusions. She reported having a headache and myalgia 2 weeks prior, which she thought was the regular flu, and symptoms improved without any treatment. Her vital signs on admission were body temperature of 99.3°F, blood pressure of 139/77 mmHg, sinus tachycardia of 114 beats/min, respiratory rate of 17 breaths/min, and oxygen saturation of 98% on room air. Physical examination was unremarkable except right neck tenderness. A computed tomography (CT) scan of the neck and soft tissue with contrast showed the right IJ vein almost entirely thrombosed from its origin at the skull base to the right subclavian vein (Figure 1-1A). Meanwhile, CT scan of the chest showed diffuse ground-glass opacity within the lungs (Figure 1-1B). The right central vein subcutaneous port-a-cath access was removed, and she was begun on systemic anticoagulation with warfarin. Additional workup showed high factor VIII, D-dimer, low serum iron, and negative blood culture. The patient was suspected of having coronavirus disease 19 (COVID-19) as a cause of IJ thrombus. Anti-SARS-CoV-2 antibodies were done and reported positive.
(A) Computed tomography (CT) scan of the neck and soft tissue with contrast showed the right internal jugular vein almost entirely thrombosed. (B) Diffuse ground-glass opacity within the lungs suggestive on CT scan of the chest.
COVID-19 is a viral infection caused by SARS-CoV-2. This disease, which eventually progressed as a pandemic, was first reported in Wuhan, China, in December 2019. As of December 2020, 66.7 million cases were reported worldwide and the mortality was 1.53 million. The major cause of COVID-19–related mortality is severe acute respiratory distress syndrome (ARDS). However, it has also been observed that COVID-19 affects all major organ systems, including the cardiovascular system. The long-term implication of COVID-19–related cardiovascular involvement is still unknown.
SARS-CoV-2 is a single-stranded, enveloped RNA virus. It belongs to the genus betacoronavirus, which is similar to the two pathogenic coronaviruses known to humankind: severe acute respiratory syndrome coronavirus (SARS-CoV) and Middle East respiratory syndrome coronavirus (MERS-CoV). Phylogenetic analysis showed that SARS-CoV-2 is closely related to bat-derived coronavirus of the genus betacoronavirus (about 88%), SARS-CoV (about 79%), and MERS-CoV (about 50%). Additionally, SARS-CoV and SARS-CoV-2 both use angiotensin-converting enzyme 2 (ACE2) as an attachment receptor to bind to the host cell, implying similarity in the biological features between them.
SARS-CoV-2 comprises four structural ...