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SESSION TITLE: Medical Student/Resident Lung Pathology SESSION TYPE: Med Student/Res Case Rep Postr PRESENTED ON: October 18-21, 2020 INTRODUCTION: Coronavirus disease 2019 (COVID-19) has caused a global pandemic in just a few months Worldwide, Health care officials are calling for social distancing and quarantine policies to limit the spread of COVID-19 This means most people will have to spend much, if not all, of their time at home Home environment offers abundant opportunities to be sedentary( sitting and reclining) The link between Immobility and increased risk of venous thromboembolism (VTE) has long been established We present a case of a young healthy patient who developed deep venous thrombosis (DVT) and bilateral acute pulmonary embolism following prolonged sitting during (COVID-19) outbreak quarantine CASE PRESENTATION: A 45-year-old male presented to our hospital with right leg pain and dyspnea of 1-week duration He denied fever, chest pain, cough, trauma, sick contact or recent travel He has no past medical history and never smoked Due to COVID-19 outbreak “stay home” orders, and, for four weeks prior to hospital presentation, he was spending about eight uninterrupted hours daily seated using his computer at home Initial vitals were Temp 98 3 F, heart rate 81 beat/min, respiratory rate 18 cycles/min, blood pressure 142/65 mmHg and oxygen saturation 100% on ambient air Physical exam was remarkable only for right calf swelling and tenderness BMI was 24 kg/m2 Laboratory data were notable for a D-dimer of 3035 (ref range;0-243 ng/ml DDU) and a creatinine of 1 5 ( ref range;0 7-1 2 mg/dl) Complete hemogram and coagulation profiles were normal Chest x ray was normal Ultrasound of the leg showed right popliteal vein DVT (Figure 1) CT angiogram of the chest confirmed multiple bilateral acute pulmonary emboli (Figures 2&3) Factor V Leiden mutation was negative and there was no protein C, S or antithrombin III deficiency Provoked VTE secondary to seated immobility was diagnosed The patient was started on enoxaparin and was thereafter transitioned to rivaroxaban on discharge DISCUSSION: Seated immobility thromboembolism (SIT) syndrome is the term used to describe VTE secondary to poor mobility due to prolonged seating Travel is a well-recognized risk factor for (SIT) syndrome A Less recognized forms of prolonged sitting are computer use, watching TV and video-gaming Many cases of VTE were described in these settings with most patients being young without other risk factors for VTE Having frequent breaks to walk and frequently moving legs is strongly advised during these activities to minimize the risk of VTE In our case, prolonged seating during computer use for more than eight hours a day is blamed for development of VTE Our patient had none of the other traditional risk factors CONCLUSIONS: People should be reminded that seated immobility, in its many and varied forms, is a risk factor for VTE During times of quarantine, maintaining active life style is good for physical as well as mental health Reference #1: 1 Beasley R, Heuser P, Raymond N SIT (seated immobility thromboembolism) syndrome: a 21st century lifestyle hazard N Z Med J 2005;118(1212):U1376 Reference #2: 2 Aldington, S , Pritchard, A , Perrin, K , James, K , Wijesinghe, M , & Beasley, R (2008) Prolonged seated immobility at work is a common risk factor for venous thromboembolism leading to hospital admission Internal Medicine Journal, 38(2), 133–135 Reference #3: 3 Healy B, Levin E, Perrin K, Weatherall M, Beasley R Prolonged work- and computer-related seated immobility and risk of venous thromboembolism J R Soc Med 2010;103(11):447-454 DISCLOSURES: No relevant relationships by Abdulla Ali, source=Web Response No relevant relationships by louisa Asare, source=Web Response No relevant relationships by Mohanad Gabani, source=Web Response No relevant relationships by Ibrahim Omore, source=Web Response No relevant relationships by Muhammad Riaz, source=Web Response
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