Hemothorax as Rare Complication from COVID-19 Infection

Introduction The novel coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 has been linked with many sequelae not typical of other respiratory viruses. One of the unique features of this virus, known as COVID coagulopathy, has been associated with bleeding and/or clotting diathesis in the setting of a prothrombotic state. This has put patients at risk for hemorrhagic complications such as frank disseminated intravascular coagulation, and antiphospholipid syndrome activation. This is a case of hemothorax as a rare complication of COVID-19 infection. Case Presentation This is the case of a 48 year old male with a history of ESRD requiring dialysis, who presented to our facility with shortness of breath. He was recently admitted a month prior to an outside facility for a dialysis catheter infection and was found to be COVID-19 positive. He received IV antibiotics and supplemental oxygen. He was discharged home with plans for IV antibiotics. He presented to our facility with five days of shortness of breath. In the ED he was afebrile, tachypneic and tested negative for COVID-19. Computed Tomography of the chest was significant for a moderate to large right pleural effusion with loculated components. The next day he underwent a thoracentesis and 600 cc of bloody pleural fluid was aspirated. He then underwent a VATS, decortication, pleurodesis a few days later as the effusion failed to resolve. Cytology of the initial thoracentesis was negative for malignant cells and pathology from the VATS was positive for fibrosis, hemorrhage with fibrin deposition and acute and chronic inflammation. Discussion Hemothorax as a complication of COVID -19 has yet to be described in the literature. Altered markers such as D-dimer and fibrinogen were associated with increased coagulation and thrombotic complications respectively. Furthermore, studies have reported intra-alveolar hemorrhages and GI bleeding in post-mortem analysis of COVID patients. This case highlights the uniqueness of this novel virus and the vast array of complications that can result from infection.