Elina Shrestha MD1*, Shoaib Ashraf MD1, Muhammad Saad MD2 and Timothy J. Vittorio MS MD2

Background: COVID-19 is associated with elevated inflammatory markers and a hypercoagulability state leading to venous thromboembolism. We present an atypical presentation of a young female with Internal Jugular Vein (IJV) thrombosis, a cause attributable to the disease.
Case: A 47-year-old female with a past medical history of diabetes mellitus, hypertension, bronchial asthma, morbid obesity, uterine cancer and iron deficiency anemia (IDA) presented to the hospital with neck swelling and pain on the right side for the last week. The patient had a low-grade fever of 100.3 degrees F at home with neck discomfort, productive cough and sore throat. She was seen in the Emergency Department about 1 week back for cough and was discharged.

A computerized tomography (CT) scan of the neck and soft tissue with contrast showed the right IJV almost entirely thrombosed from its origin at the skull base to the right subclavian vein and mild pulmonary edema suspected by diffuse ground glass opacity within the lungs.

The patient was receiving intravenous iron therapy for IDA through a porta-catheter, placed 7 months ago. The right central vein subcutaneous porta-catheter access was removed, begun on systemic anticoagulation with Warfarin. SARS-CoV-2 RT-PCR was not done in this visit. On follow up, Anti-SARS-CoV-2 antibodies were positive. A repeat CT scan of the neck after 6 months of anticoagulation was done, and the thrombus was resolved.

Conclusion: We would like to emphasize more about the hypercoagulability in SARS-CoV-2 patients and broaden our vision for all possibilities of thrombosis, like the IJV thrombosis in our patient. We recommend a full hypercoagulability workup and imaging for prompt diagnosis and management of thromboembolic events in SARS-CoV-2 patients. There should be a low threshold for the SARS-CoV-2 PCR test and a vigilant attitude while we discover more of the disease.

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