Case Report: Asymptomatic COVID-19 patient with a subtle hypercoagulable state and fluctuating D-dimer level.
Jefferson Caesario, Decsa M Hertanto, Kukuh D Hernugrahanto, Dwikora N Utomo, Nicolaas C Budhiparama, Djoko Santoso, Pancras C W Hogendoorn
Author Information
Jefferson Caesario: Faculty of Medicine, Airlangga University, Surabaya, 60286, Indonesia. ORCID
Decsa M Hertanto: Department of Internal Medicine, Faculty of Medicine, Airlangga University, Surabaya, 60286, Indonesia. ORCID
Kukuh D Hernugrahanto: Department of Orthopaedic & Traumatology, Faculty of Medicine, Airlangga University, Surabaya, 60286, Indonesia.
Dwikora N Utomo: Department of Orthopaedic & Traumatology, Faculty of Medicine, Airlangga University, Surabaya, 60286, Indonesia.
Nicolaas C Budhiparama: Nicolaas Institute of Constructive Orthopaedic Research and Education Foundation for Arthroplasty and Sports Medicine, Medistra Hospital, Jakaarta, 12950, Indonesia.
Djoko Santoso: Department of Internal Medicine, Faculty of Medicine, Airlangga University, Surabaya, 60286, Indonesia.
Pancras C W Hogendoorn: Department of Pathology, Leiden University Medical Center, Leiden, 2333, The Netherlands.
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. 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. 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.
