“Endothelial Dysfunction the Common Link”
Front Pharmacol 11:588384. Case Report: Central Retinal Artery Occlusion in a COVID-19 Patient Andrea Montesel 1, Claudio Bucolo 2, Victoria Mouvet 1, Emmanuelle Moret 1, Chiara M Eandi 1 Affiliations
1Department of Ophthalmology, Fondation Asile des Aveugles, Jules Gonin Eye Hospital, University of Lausanne, Lausanne, Switzerland.
2Department of Biomedical and Biotechnological Sciences, Section of Pharmacology, University of Catania, Catania, Italy.
Abstract We report a case of central retinal artery occlusion (CRAO) in a patient with a previous history of severe COVID-19 disease. This disease has been associated with inflammatory-induced homeostasis changes leading to endothelial dysfunction and a procoagulant state with multi-organ involvement, but the burden of thromboembolic complications in COVID-19 patients is currently unknown. The pathogenesis of retinal artery occlusions is a multifactorial process where inflammation and hypercoagulation state are established risk factors. Even if our experience may represent a coincidental relationship, it is likely that COVID-19 patients could be at risk of developing retinal vascular occlusions. A focused ophthalmological surveillance is advisable to prevent and manage this possible cause of severe vision loss that has an important impact in health care system. Keywords: SARS-CoV-2; case report; central retinal artery occlusion; coronavirus disease-2019; severe acute respiratory syndrome coronavirus 2; thrombosis. Copyright © 2020 Montesel, Bucolo, Mouvet, Moret and Eandi. Discussion The COVID-19 disease has been described to induce inflammatory-induced homeostasis changes that predispose to thrombotic disease in both venous and arterial circulation (Levi et al., 2020; Levolger et al., 2020). Post-mortem analysis showed evidence of direct viral infection of the endothelial cells and diffuse endothelial inflammation leading to endothelial dysfunction and a procoagulant state (Varga et al., 2020). The risk of thromboembolic events in COVID-19 patients is currently under investigation, with preliminary results showing significantly prolonged prothrombin time, high D-dimer levels and increased concentrations of proinflammatory cytokines and biomarkers of inflammation in patients with more severe disease, indicating the likelihood of disseminated intravascular coagulation or thrombotic microangiopathy (Connors and Levy, 2020; Levi et al., 2020). Even though most cases are affected by venous thromboembolism (Llitjos et al., 2020), there are increasing reports of COVID-19 induced arterial thromboembolic complications, highlighting the thrombogenicity of SARS-CoV-2 infection (Levolger et al., 2020). Lodigiani et al. (2020) in a cohort of 388 consecutive patients with laboratory-proven COVID-19 requiring hospital admission, disclosed a remarkable rate of venous and arterial thromboembolic complications of approximately 8% despite the use of anticoagulant prophylaxis (Lodigiani et al., 2020). It is also well established that a considerable percentage of subjects infected by the coronavirus develop a mild infection or are asymptomatic, and in these cases the clinical and histopathology data available are limited. Hence, the burden of thromboembolic complications in COVID-19 patients is currently unknown, with some authors suggesting that it may represent an underestimated, large-scale issue (Lodigiani et al., 2020)… View Full-Text