COVID with jaundice and r...

A male in his early 50s had a history of hypertension and obstructive sleep apnea. On admission, he was not taking any medications. With his hypertension, he had suffered with the side effects of bisoprolol and ramipril. Aspirin and atorvastatin had been prescribed to him, but he had avoided taking them. Since October of this year, he did not require medications to control his blood pressure.

Presenting Symptoms

The patient was hospitalized after complaining of feeling unwell for five days. A yellow discoloration in his eyes had been found by his relatives. He had a frank per rectum (PR) bleeding episode and his urine was black. 6 months prior to admission, he identified a previous episode of PR bleeding. He had one bout of diarrhea before.

Examination

Except for moderate jaundice, his clinical evaluation was unremarkable. There was no blood or melaena on PR. On room air, his blood pressure was 173/104 mm Hg, his heart rate was 110 beats per minute, his temperature was 36.4°C, his respiratory rate was 20 beats per minute, and his oxygen saturation was 96 percent.

Acute kidney injury (AKI) stage 1 was present, as was elevated bilirubin.

On admission, his ECG revealed sinus tachycardia with a heart rate of 122 beats per minute.

Protein and blood were found in the urine. A vasculitis screen was performed due to the irregular renal activity, elevated blood pressure, and positive urine dip. This was negative. Further studies were carried out as a result of the suspected hemolysis, as detailed below.

Diagnosis 

Hemolytic anemia secondary to Covid-19 infection.