Delayed Bilateral Pulmonary Embolism Six Months after Mild SARS-CoV-2 Infection: A Case Report

Abstract

Introduction: Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) has been one of the most globally impactful diseases. It has been associated with significant morbidity and mortality, particularly due to acute respiratory distress syndrome (ARDS) in the acute stage. Venous Thromboembolism (VTE), particularly pulmonary embolism is well associated in the acute stages. Occurrence after initial recovery remains a rare encounter. Case Presentation: A 49-year-old previously healthy gentleman was admitted following an acute onset severe shortness of breath. On examination he was tachypneic, tachycardic with clear lungs on auscultation. He had a S1Q3T3 pattern on his ECG with elevated d-dimer. Computed Tomography Pulmonary Angiogram revealed bilateral pulmonary embolism. There were no risk factors for VTE other than a mild SARS-CoV-2 infection 6 months back with persistent low grade systemic inflammation. Malignancy and thrombophilia screening was  negative. Conclusion: This case report highlights the possibility of the pro-coagulopathy state caused by SARS-Cov-2 virus infection to persist for a prolonged period even following a mild clinical infection. It raises the concern regarding the need for prolonged anticoagulation even after recovering from the initial infection.