Transcatheter arterial embolization for unilateral active adrenal hemorrhage that developed after COVID-19 infection: A case report

Abstract

Abstract Background: Adrenal hemorrhage is rare with only a few reports of coronavirus disease 2019 (COVID-19)-related adrenal hemorrhage. Herein, we report a case of transcatheter arterial embolization for a unilateral active adrenal hemorrhage that developed after COVID-19. Case presentation: A 73-year-old, previously healthy man presented to our hospital with sudden right-sided abdominal pain. The patient had a past medical history of hypertension, glaucoma, and COVID-19 without other history of abdominal trauma, anticoagulant use, or neoplastic or autoimmune disease. Urgent transcatheter arterial embolization was performed for an active right adrenal hemorrhage; the middle adrenal artery was embolized with 33% n-butyl-2-cyanoacrylate to manage the extravasation. Follow-up computed tomography performed three days later showed that the hematoma had shrunk. Various tests were performed on the day after admission to determine the cause of the adrenal hemorrhage. However, no suspected causes other than Covid-19 infection, including neoplastic diseases, were identified. The general condition of the patient was good; therefore, he was discharged after only one week of hospitalization. Conclusion: We encountered a case of unilateral adrenal hemorrhage that developed after COVID-19 infection. COVID-19 infection may cause an increased risk of bleeding or thromboembolism and the exact frequency of adrenal hemorrhage secondary to COVID-19 remains unknown; however, COVID-19 infection may cause an increased bleeding risk or thromboembolism. Hence, clinicians should be aware that adrenal hemorrhage is a possible delayed consequence of COVID-19 infection.