Triple-site Thrombosis: A Rare Case of Cardiopulmonary and Popliteal Thrombosis in a COVID-19 Positive Female Patient

Background We present a rare case of COVID-19 infection with venous thrombosis at three sites—right ventricular thrombus, bilateral pulmonary artery thromboembolism, and bilateral lower limb deep vein thrombosis. Case Presentation A 55-year-old female presented with a history of dry cough and low-grade fever for 3 days, associated with generalized weakness. On examination, she was tachypneic, tachycardic, and hypoxic, requiring oxygen supplementation. She tested positive for COVID-19 disease with a computed tomography (CT) severity score of 22/25. She was treated with remdesivir, steroids, and anticoagulants. CT pulmonary angiogram revealed a large right ventricular thrombus and a partial thrombosis of the right and left pulmonary arteries. Venous Doppler of bilateral lower limbs showed acute deep venous thrombosis (DVT) in bilateral popliteal veins extending to calf veins. Therapeutic anticoagulation with low-molecular-weight heparin was initiated. The patient got symptomatically better. The patient was discharged in a stable condition and was kept under follow-up. On follow-up, the patient showed improvement with anticoagulation therapy. The follow-up echocardiography showed no evidence of thrombus, venous Doppler of bilateral lower limbs showed no DVT, and the elevated D-dimer levels gradually returned to the normal range. The 5-month recovery period had been uneventful. Conclusion The diagnosis of venous thromboembolism (VTE) is quite challenging in COVID-19 patients due to the similarity in the clinical presentation of an event of VTE and a primary underlying COVID-19 pneumonia. Hence, a high clinical suspicion and prompt evaluation in patients with high D-dimer levels and appropriate predisposing risk factors are advised.