Case Report: Asymptomatic COVID-19 patient with a subtle hypercoagulable state and fluctuating D-dimer level

F1000Research, vol. 10, pp. 1112

Abstract

Background: COVID-19 can infect an asymptomatic person silently without any overt symptoms despite diffuse blood clots throughout the body. Clot formation is induced by COVID-19 associated coagulopathy that can cause a high mortality rate. D-dimer, a fairly decisive marker for the coagulopathy event, is physiologically a marker of the fibrinolysis process. The increase of D-dimers in COVID-19 cases must be followed up because it relates to the initiation of a cytokine storm. Case presentation: We report an asymptomatic patient with sudden D-dimer elevation who received anticoagulant therapy. After three days of heparin administration, D-dimer results became normal and anticoagulant therapy was stopped. However, on the 12th day, the D-dimer level rebounded back and was followed by an increase of hs-C-reactive protein, erythrocyte sedimentation rate, IL-6, although SARS-CoV-2 PCR result became negative. A hyperglycaemic reaction and a sudden increase of HbA1C was observed in the patient. After three weeks D-dimer had returned to normal levels, and so did the other markers. The patient recovered fully and still no symptoms were obvious. Conclusion: COVID-19 patients without symptoms may be at risk of an asymptomatic coagulopathy process. The decreasing level of D-dimer erroneously cannot ensure that the coagulopathy process stops.

Authors 7

1. Jefferson Caesario

   Universitas Airlangga

   Affiliation as printed

   Faculty of Medicine, Airlangga University, Surabaya, 60286, Indonesia

   Faculty of Medicine, Airlangga University, Surabaya, 60286

2. Decsa Medika Hertanto

   Universitas Airlangga

   Affiliation as printed

   Department of Internal Medicine, Faculty of Medicine, Airlangga University, Surabaya, 60286, Indonesia

   Department of Internal Medicine, Faculty of Medicine, Airlangga University, Surabaya, 60286

3. Kukuh Dwiputra Hernugrahanto

   Universitas Airlangga

   Affiliation as printed

   Department of Orthopaedic & Traumatology, Faculty of Medicine, Airlangga University, Surabaya, 60286, Indonesia

   Department of Orthopaedic & Traumatology, Faculty of Medicine, Airlangga University, Surabaya, 60286

4. Dwikora Novembri Utomo

   Universitas Airlangga

   Affiliation as printed

   Department of Orthopaedic & Traumatology, Faculty of Medicine, Airlangga University, Surabaya, 60286, Indonesia

   Department of Orthopaedic & Traumatology, Faculty of Medicine, Airlangga University, Surabaya, 60286

5. Nicolaas Cyrillus Budhiparama Aachen Department of Orthopaedic Surgery

   Universitas Airlangga · Leiden University Medical Center

   Affiliation as printed

   Department of Orthopaedic Surgery, Leiden University Medical Center, Leiden, 2333, The Netherlands

   Faculty of Vocational Studies, Airlangga University, Surabaya, 60286, Indonesia

   Nicolaas Institute of Constructive Orthopaedic Research and Education Foundation for Arthroplasty and Sports Medicine, Medistra Hospital, Jakaarta, 12950, Indonesia

   Department of Orthopaedic Surgery, Leiden University Medical Center, Leiden, 2333

   Faculty of Vocational Studies, Airlangga University, Surabaya, 60286

   Nicolaas Institute of Constructive Orthopaedic Research and Education Foundation for Arthroplasty and Sports Medicine, Medistra Hospital, Jakaarta, 12950

6. Djoko Santoso corresponding

   Universitas Airlangga

   Affiliation as printed

   Department of Internal Medicine, Faculty of Medicine, Airlangga University, Surabaya, 60286, Indonesia

   Department of Internal Medicine, Faculty of Medicine, Airlangga University, Surabaya, 60286

7. Pancras C.W. Hogendoorn Aachen Department of Pathology, Leiden University Medical Center

   Leiden University Medical Center

   Affiliation as printed

   Department of Pathology, Leiden University Medical Center, Leiden, 2333, The Netherlands

   Department of Pathology, Leiden University Medical Center, Leiden, 2333