Dados do Trabalho

TÍTULO

HEMORROIDAL THROMBOSIS AS ONLY CLINICAL SIGN OF COVID-19 DIAGNOSIS

OBJETIVO

The COVID-19 pandemic struck Brazil in March 2020, and since then the country counted more than half-million victims. Since the first autopsies performed in Rome and after understanding the haematological nature of this infectious disease, coagulation disorders are frequently found in patient diagnosed with COVID-19.In particular, thrombosis is at the base of severe COVID-19 cases. This small case series presents 8 patients whose only initial symptom and sign of COVID-19 infection was haemorrhoidal thrombosis, without any other clinical manifestation, especially in the respiratory tract. There are no other case reports published until now about a similar clinical presentation.

MÉTODO

This small observational study started in November 2020 and ended in June 2021. 8 patients (5 males and 3 women), aged 28-45(mean age 39,6) presented in clinic with a sudden onset anal pain and rectal bleeding. None of them suffered from haemorrhoidal disease before, and all related a sudden onset of the symptoms. All patients were examined and a diagnosis of haemorrhoidal thrombosis was made. All were prescribed with a steroid-based ointment, NSAIDs and lactulose. The strange presentation, the isolated symptom and the sudden onset of pain (not related to constipation straining, spicy food abuse or heavy weight lifting), and the initial knowledge of the peculiar characteristics of the disease, motivated the prescription of a COVID-19 RT PCR test for all of them. All resulted positive for COVID-19 infection. All patients were immediately referred to a pneumologist for clinical care.

RESULTADOS

Every patient was followed-up by telemedicine for 30 days, with blood tests investigating coagulation and PCR. All presented altered d-dimer results. Two patients (1 woman and 1 man) presented mild respiratory distress after 1 week and underwent a CT-scan showing pulmonary damage of less than 25% of the lungs, with typical ground-glass lesions, not requiring hospital admission. Every patient received symptomatic care from the pneumologist and overcome the infection without any complications.
All patients returned in clinic after 6 weeks, and received a full clinical examination showing no sign of haemorrhoidal disease left.
All patients underwent a colonoscopy after 1 month with a negative result

CONCLUSÕES

COVID-19 showed somehow protean clinical manifestations. Sudden onset of haemorrhoidal thrombosis, not linked to the classical situation involving straining, spicy food abuse, constipation or diarrhoea, together with a somewhat atypical clinical presentation must arise the doubt of a latent COVID-19 infection. More cases are needed in order to really define this symptom as one of the many involved in COVID-19 clinical course.

PALAVRAS CHAVE

COVID-19, HAEMORROIDS, SIGN, ATYPICAL, THROMBOSIS