Adrenal haemorrhage as a complication of COVID-19 infection

BMJ Case Rep. 2020 Nov 30;13(11):e239643. doi: 10.1136/bcr-2020-239643.

Abstract

We report an unusual complication of COVID-19 infection in a 53-year-old Caucasian man. He presented with shortness of breath, fever and pleuritic chest pain. A CT pulmonary angiogram (CTPA) demonstrated acute bilateral pulmonary embolism and bilateral multifocal parenchymal ground glass change consistent with COVID-19 (SARS-CoV-2) infection. Right adrenal haemorrhage was suspected on the CTPA which was confirmed on triple-phase abdominal CT imaging. A short Synacthen test revealed normal adrenal function. He was treated initially with an intravenous heparin infusion, which was changed to apixaban with a planned outpatient review in 3 months' time. He made an uncomplicated recovery and was discharged. Follow-up imaging nearly 5 months later showed near complete resolution of the right adrenal haemorrhage with no CT evidence of an underlying adrenal lesion.

Keywords: adrenal disorders; infections; radiology.

Publication types

  • Case Reports

MeSH terms

  • Adrenal Cortex Function Tests / methods
  • Adrenal Gland Diseases* / diagnosis
  • Adrenal Gland Diseases* / etiology
  • Adrenal Gland Neoplasms / diagnosis
  • Adrenal Glands / diagnostic imaging*
  • Antithrombins / administration & dosage
  • COVID-19* / complications
  • COVID-19* / diagnosis
  • COVID-19* / physiopathology
  • COVID-19* / therapy
  • Clinical Deterioration
  • Computed Tomography Angiography / methods*
  • Diagnosis, Differential
  • Hemorrhage* / diagnosis
  • Hemorrhage* / etiology
  • Heparin / administration & dosage*
  • Humans
  • Male
  • Middle Aged
  • Pulmonary Embolism* / diagnosis
  • Pulmonary Embolism* / etiology
  • Pulmonary Embolism* / physiopathology
  • Pulmonary Embolism* / therapy
  • Pyrazoles / administration & dosage*
  • Pyridones / administration & dosage*
  • SARS-CoV-2 / isolation & purification
  • SARS-CoV-2 / pathogenicity
  • Treatment Outcome

Substances

  • Antithrombins
  • Pyrazoles
  • Pyridones
  • apixaban
  • Heparin