Pulmonary, Cerebral, and Renal Thromboembolic Disease in a Patient with COVID-19

An 84-year-old man with a past medical history of hypertension was brought to the emergency department in respiratory distress after being found at home with oxygen saturation of 40%.The patient reported fever, shortness of breath, cough, and abdominal pain for 2 weeks leading up to presentation.On examination, he was found to have a nonreactive, pinpoint left pupil and new onset atrial fibrillation with rapid ventricular response.Laboratory analysis revealed lymphopenia of 0.29 x 10 3 /uL, procalcitonin of 0.25 ng/mL, elevated D-dimer of 21.6 mcg/mL, and elevated troponin T of 35 ng/mL.Reverse transcription polymerase chain reaction (RT-PCR) COVID-19 testing was positive.As his respiratory status deteriorated, the patient was expeditiously intubated.CT of the chest performed on the night of admission revealed diffuse ground-glass opacities and bibasilar consolidations compatible with severe COVID-19 pneumonia, as described in a recent consensus statement (1).In addition, chest CT demonstrated bilateral lobar pulmonary emboli (Fig 1).The patient was started on a low-molecular-weight heparin infusion.CT of the abdomen and pelvis, performed concurrently with the chest CT, demonstrated a new left renal infarct (Fig 2).