LAUSR

A 62 years old male with a history of hypertension and asthma presented to the emergency department after sudden onset of left upper quadrant abdominal pain. The patient had been discharged from the hospital 2 days prior, when he had presented for 10 days duration of shortness of breath and was diagnosed with moderate COVID-19 infection. Patient had required oxygen by nasal cannula for the first 3 days of his hospital stay, and was discharged on the fourth day. During his entire stay he was receiving venous thromboembolism prophylaxis with low molecular weight heparin. Patient denied history of tobacco, alcohol or recreational drug use. On presentation the patient was hemodynamically stable; his physical exam revealed left upper quadrant abdominal tenderness but was otherwise unremarkable. ECG showed normal sinus rhythm. Lab studies were notable for a D-dimer of 2672 ng/mL, and positive Antiphospholipid antibodies, specifically Anticardiolipin IgM antibodies. Urinalysis was normal. Computerized Tomography of the abdomen and pelvis with intravenous contrast demonstrated left renal infarcts, as well as a thrombus in the left renal arterial branch (Fig. 1). Additional findings of bibasilar opacities consistent with known COVID-19 pneumonia were also noted. The patient was started on anticoagulation with Heparin, then transitioned to a novel oral anticoagulant and discharged home. The patient was contacted 6 weeks after discharge, reported feeling well, denied any complications. Repeat blood work four weeks after discharge showed stable kidney function. Discussion