Spontaneous muscle hematomas presenting with hemorrhagic shock in critically ill patients with SARSCoV- 2 pneumonia
Authors: Diana Zamudio, Guillermo Egea, Sara G Zamorano
Background: Spontaneous muscle hematomas (SMH) are rare but potentially life-threatening. We report three patients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pneumonia who developed hemorrhagic shock, due to large SMHs, during their intensive care unit stay. Case Presentation: All the patients were receiving mechanical ventilation and anticoagulation therapy with enoxaparin. The bleeding was located in the gluteal muscles in two of the patients and in the iliopsoas muscle with retroperitoneal extension in the other. Anemia and hemodynamic instability were the main signs; however, because of their gradual onset, they were initially confused with the anemia of the critically ill patient and sepsis related to secondary infections. All received conservative medical treatment, but unfortunately one patient died within hours of diagnosis. Conclusion: This report highlights that clinicians should also be alert to major spontaneous hemorrhage in patients with SARSCoV- 2 infection. Since it is a novel disease, a possible association with bleeding events cannot be disregarded and, on the contrary, should be considered, particularly to determine the appropriate use of anticoagulation in this type of patients.
Keywords: Coronavirus, COVID-19, SARS-CoV-2, muscle hematomas, hemorrhagic shock, retroperitoneal bleeding.
Authors
Correspondence to:
Diana Zamudio, Department of Anesthesiology and Critical Care, Alcorcon Foundation University Hospital, Madrid, Spain dianarocio.zamudio@salud.madrid.org
Publication history:
Received 07 Mar 2021
Accepted 19 Sep 2021
Published online 19 Oct 2021
Published in print 26 Oct 2021
Zamudio D, Egea G, Zamorano SG. Spontaneous muscle hematomas presenting with hemorrhagic shock in critically ill patients with SARSCoV- 2 pneumonia. EJMCR. 2021; 5(9): 260-264. doi:
10.24911/ejmcr/173-1615055105
Zamudio D, Egea G, Zamorano SG. Spontaneous muscle hematomas presenting with hemorrhagic shock in critically ill patients with SARSCoV- 2 pneumonia. https://www.ejmcr.com/?mno=61814 [Access: March 29, 2024]. doi:
10.24911/ejmcr/173-1615055105
Zamudio D, Egea G, Zamorano SG. Spontaneous muscle hematomas presenting with hemorrhagic shock in critically ill patients with SARSCoV- 2 pneumonia. EJMCR. 2021; 5(9): 260-264. doi:
10.24911/ejmcr/173-1615055105
Zamudio D, Egea G, Zamorano SG. Spontaneous muscle hematomas presenting with hemorrhagic shock in critically ill patients with SARSCoV- 2 pneumonia. EJMCR. (2021), [cited March 29, 2024]; 5(9): 260-264. doi:
10.24911/ejmcr/173-1615055105
Zamudio, D., Egea, . G. & Zamorano, . S. G. (2021) Spontaneous muscle hematomas presenting with hemorrhagic shock in critically ill patients with SARSCoV- 2 pneumonia. EJMCR, 5 (9), 260-264. doi:
10.24911/ejmcr/173-1615055105
Zamudio, Diana, Guillermo Egea, and Sara G. Zamorano. 2021. Spontaneous muscle hematomas presenting with hemorrhagic shock in critically ill patients with SARSCoV- 2 pneumonia. European Journal of Medical Case Reports, 5 (9), 260-264. doi:
10.24911/ejmcr/173-1615055105
Zamudio, Diana, Guillermo Egea, and Sara G. Zamorano. "Spontaneous muscle hematomas presenting with hemorrhagic shock in critically ill patients with SARSCoV- 2 pneumonia." European Journal of Medical Case Reports 5 (2021), 260-264. doi:
10.24911/ejmcr/173-1615055105
Zamudio, Diana, Guillermo Egea, and Sara G. Zamorano. "Spontaneous muscle hematomas presenting with hemorrhagic shock in critically ill patients with SARSCoV- 2 pneumonia." European Journal of Medical Case Reports 5.9 (2021), 260-264. Print. doi:
10.24911/ejmcr/173-1615055105
Zamudio, D., Egea, . G. & Zamorano, . S. G. (2021) Spontaneous muscle hematomas presenting with hemorrhagic shock in critically ill patients with SARSCoV- 2 pneumonia. European Journal of Medical Case Reports, 5 (9), 260-264. doi:
10.24911/ejmcr/173-1615055105