A rare esophageal hematoma in a COVID-19 ARDS patient: a case report and literature review

Acute Respiratory Distress Syndrome (ARDS), a severe manifestation of COVID-19, often requires anticoagulation therapy such as enoxaparin to prevent thromboembolic events. However, this treatment can increase the risk of gastrointestinal bleeding, including esophageal hemorrhage. We present a case of a 64-year-old man with ARDS and COVID-19 who developed significant oesophageal hematoma during enoxaparin therapy. Laboratory findings revealed prolonged PT (15.2 s), PTT (45.8 s), INR (1.4), and reduced fibrinogen levels, suggesting a predisposition to bleeding. Initially admitted with severe respiratory symptoms and treated with CPAP, he was also given enoxaparin and aspirin. The patient developed mild thrombocytopenia and subsequently, a CT scan revealed an oesophageal hematoma. He required blood transfusions and inotropes, but the hematoma and thrombocytopenia resolved following the discontinuation of enoxaparin. This case highlights the complex management of anticoagulation in COVID-19 patients, emphasizing the need for careful monitoring and a multidisciplinary approach. Given the increased risk of esophageal hematoma in anticoagulated ARDS patients, this report underscores the importance of balancing anticoagulation benefits with potential risks and suggests the need for tailored treatment strategies in managing ARDS patients with concurrent COVID-19.