Synchronous Hepatic Artery and Portal Vein Thrombosis in COVID-19 infection- A case report

Background: COVID-19, which primarily affects the respiratory system, can also lead to systemic complications, including thrombotic events. Althoughthromboses in the hepatic and portal systems are rare, they mayresult in serious complications. This case report presents a unique scenario of concomitant hepatic artery and portal vein thrombosis in a patient with previously undiagnosed essential thrombocytosis who also tested positive for COVID-19. It underscores the importance of early identification of thrombotic complications and underlying hematologic disorders. Case Presentation: A 38-year-old female presented with fever, abdominal pain, cough, and shortness of breath. She tested positive for COVID-19 and was found to have hepatic artery thrombosis and multiple liver infarcts on a contrast-enhanced CT scan. Further imaging revealed complete thrombosis of the celiac artery and its branches, portal vein thrombosis, and splenic infarction. Initial management included intravenous fluids and enoxaparin. During hospitalization, persistent thrombocytosis led to a diagnosis of essential thrombocytosis. Hydroxyurea was initiated for cytoreductive therapy. The patient’s condition improved, and she was discharged on dabigatran. At an eight-month follow-up, she remained asymptomatic, with normal liver function and no recurrence of thrombosis. Conclusions: This case demonstrates the crucial need torecognize unusual thrombotic patterns in COVID-19, especially in individuals harboring undiagnosed hematologic disorders like essential thrombocytosis. Prompt diagnosis and aggressive treatment, including anticoagulation and cytoreductive therapy, are important to avert serious outcomes and support successful recovery.