Giant Abdominal Haematoma and Rapid Multidrug-Resistant Infection After Low-Molecular-Weight Heparin in a Patient With COVID-19 and Rheumatoid Arthritis
Abstract
Background: Low-Molecular-Weight Heparin (LMWH) is a widely used anticoagulant in clinical practice during the COVID-19 pandemic. However, the risk of adverse reactions increases significantly in patients with multiple underlying diseases and immune dysfunction. This article reports a case of a patient with COVID-19 complicated with rheumatoid arthritis who had long-term oral prednisone (5 mg/d) for rheumatoid arthritis, who developed a rare giant hematoma (15cm×15cm) after LMWH administration, which rapidly progressed to sequential infections caused by multidrug-resistant organisms, including extended-spectrum β-lactamase (ESBL)-producing Escherichia coli and carbapenem-resistant Acinetobacter baumannii (CRAB), within one day. This case describes the complexity and severity of adverse drug reactions under the superposition of multiple factors, and offers clinical insights for diagnosis and management.
Case summary: A 61-year-old female patient was admitted to the hospital for treatment of "viral pneumonia and COVID-19". Her underlying diseases included rheumatoid arthritis (long-term oral prednisone 5mg/d), hypertension, and type 2 diabetes mellitus. After admission, the patient was given subcutaneous injection of LMWH (2500 IU, qd) for anticoagulation, combined with Simnotrelvir/Ritonavir for antiviral treatment. On the 9th day of medication, a giant hematoma of about 15cm×15cm appeared at the LMWH injection site; on the 10th day of medication, the hematoma rapidly…
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