Case Report
Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Infect Dis. Sep 18, 2020; 10(3): 42-46
Published online Sep 18, 2020. doi: 10.5495/wjcid.v10.i3.42
Abdominal aortic thrombosis as initial presentation of COVID-19 infection: A case report
William Zachary Webster, Amrit Sraow, Karla Cruz Morel
William Zachary Webster, Department of Internal Medicine, University of South Carolina School of Medicine, Columbia, SC 29203, United States
Amrit Sraow, Karla Cruz Morel, Department of Pulmonary and Critical Care Medicine, University of South Carolina School of Medicine-Prisma Health, Columbia, SC 29203, United States
Author contributions: Webster WZ wrote the original manuscript with comprehensive review of the literature on the topic; Cruz Morel K edited the initial report and contributed to literature review; Sraow A also contributed to editing the report.
Informed consent statement: Informed consent has been obtained by all authors to publish this manuscript. Additionally, informed consent was obtained from the patient to publish this manuscript with the understanding that all identifying information has been omitted.
Conflict-of-interest statement: There are no conflicts of interest by any other the authors of this manuscript including Drs. William Webster, Amrit Sraow, and Karla Cruz-Morel.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Corresponding author: William Zachary Webster, MD, Doctor, Department of Internal Medicine, University of South Carolina School of Medicine, 5 Richland Medical Park Dr., Columbia, SC 29203, United States.
Received: July 7, 2020
Peer-review started: July 9, 2020
First decision: July 21, 2020
Revised: August 2, 2020
Accepted: September 1, 2020
Article in press: September 1, 2020
Published online: September 18, 2020

The hypercoagulable state associated with coronavirus disease 2019 (COVID-19) has been shown to complicate the course of this viral illness with both venous and arterial clots. Often presenting after hospitalization and known COVID-19 diagnosis, the etiology of thrombosis has been attributed to the hyperinflammatory state and endothelial dysfunction associated with COVID-19. This report portrays a patient who experienced an aortic thrombosis resulting in back and leg pain with subsequent loss of motor function of his legs as his initial presentation of COVID-19.


Patient is a 60-year-old Caucasian male with no medical history who presented with sudden onset pain in his lower back and lower extremities. He went on to experience complete motor loss of the lower extremities two hours after admission. Chest pain and shortness of breath developed one day later but were not present at time of presentation. Computed tomography angiography of the chest, abdomen, and pelvis revealed occlusion by thrombosis of the abdominal aorta in addition to multifocal pulmonary ground-glass opacities prompting COVID-19 PCR, which was positive. He was taken to surgery for attempted thrombectomy and the thrombus was retrieved starting from the right common femoral artery, but a second thrombus had immediately reformed in place of the prior thrombectomy site resulting in conclusion of the procedure. He was continued on unfractionated heparin and received a dose of tocilizumab 400 mg, but rapidly developed hemodynamic compromise and expired from cardiac arrest.


This presentation emphasizes the importance of evaluating patients for COVID-19 who experience unusual thromboses without superior explanation.

Keywords: COVID-19, Aortic thrombosis, Arterial thrombosis, Atypical COVID-19 presentation, COVID-19 complication, Case report

Core Tip: Aortic thrombosis preceding respiratory symptoms should raise suspicion for testing for coronavirus disease 2019 in patients with unusual thrombosis presentation.