Glioblastoma dengan Deep Vein Thrombosis pada pasien COVID-19: Sebuah Laporan Kasus

Authors

  • Dodik Tugasworo Departemen Neurologi, RSUP Dr. Kariadi Semarang, Indonesia
  • Aditya Kurnianto Departemen Neurologi, RSUP Dr. Kariadi Semarang, Indonesia
  • Retnaningsih Retnaningsih Departemen Neurologi, RSUP Dr. Kariadi Semarang, Indonesia
  • Yovita Andhitara Departemen Neurologi, RSUP Dr. Kariadi Semarang, Indonesia
  • Rahmi Ardhini Departemen Neurologi, RSUP Dr. Kariadi Semarang, Indonesia
  • Dody Priambada Departemen Bedah Saraf, RSUP Dr. Kariadi, Semarang, Indonesia
  • Daynuri Daynuri Program Studi Ilmu Penyakit Saraf, Fakultas Kedokteran Universitas Diponegoro Semarang, Indonesia

DOI:

https://doi.org/10.36408/mhjcm.v7i1A.468

Keywords:

glioblastoma, DVT, COVID-19

Abstract

Latar belakang: Glioblastoma (GBM) berhubungan dengan peningkatan hiperkoagulabilitas dan peningkatan risiko dari venous thromboembolism (VTE) (termasuk Deep Vein Thrombosis (DVT)). VTE merupakan komplikasi kardiovaskular atau respirasi yang sering ditemukan pada pasien-pasien yang dirawat inap karena COVID-19. Hubungan mengenai VTE pada kasus GBM dan COVID-19 belum pernah dibahas sebelumnya. Laporan kasus ini akan membahas tentang seorang wanita usia 55 tahun dengan GBM dan DVT dengan hasil PCR SARS-CoV-2 positif yang dirawat di RSUP Dr. Kariadi.

Laporan kasus: Wanita 55 tahun datang ke rumah sakit dengan nyeri kepala dan nyeri serta bengkak pada tungkai kanan. Pada pemeriksaan laboratorium didapatkan INR 0.92, D-Dimer kuantitatif 46540 ug/L, dan titer fibrinogen kuantitatif 234 mg/dL. Dari USG vena doppler tungkai kanan didapatkan gambaran DVT sepanjang vena tungkai kanan, pada pemeriksaan MRI kepala dan biopsi tumor sesuai dengan gambaran GBM, hasil pemeriksaan foto rontgen thoraks terjadi perburukan gambaran paru, serta pemeriksaan PCR SARS-CoV-2 positif. Pembahasan: Pada pasien ini, kondisi GBM dapat menyebabkan adanya kondisi hiperkoagulabilitas akibat neoangiogenesis, mutase onkogenik, dan aktivitas kronik kaskade koagulasi. Selain itu, infeksi dan inflamasi yang berat berkontribusi dalam berkembangnya DVT, seperti yang ditemukan pada pasien dengan COVID-19 yang parah. Pada pasien rawat inap dengan COVID-19, prevalensi DVT tinggi dan biasanya memiliki outcome yang buruk. Istilah COVID-19 associated coagulopathy (CAC) digunakan untuk menggambarkan perubahan koagulasi pada pasien yang terinfeksi COVID.

Simpulan: Peningkatan risiko DVT pada pasien dengan glioblastoma dan infeksi COVID-19 disebabkan hiperkoagulabilitas dan koagulopati akibat sel tumor dan virus SARS-CoV-2.

Kata Kunci: glioblastoma, DVT, COVID-19

 

Introduction: GBM is associated with increased of hypercoagulability and the risk of venous thromboembolism (VTE) (include Deep Vein Thrombosis (DVT)). VTE is a cardiovascular or respiratory complication that is often found in patients with COVID-19. The relationship of VTE in GBM and COVID-19 has not been discussed before. This case report will discuss a 55-year-old woman with GBM and DVT with a positive SARS-CoV-2 treated at Dr. Kariadi Hospital.

Case presentation: A 55-year-old woman came to the hospital with cephalgia, pain and redness in the right leg. On laboratory examination, it was obtained INR 0.92, quantitative D-Dimer 46540 ug/L, and quantitative fibrinogen titer 234 mg/dL. Venous doppler USG of right leg showed the imaging of DVT along the venous system in right leg. Head MRI and tumor biopsy showed the imaging of GBM, on the chest X-ray examination showed the deterioration of the lung damage, and positive SARS-CoV-2 with PCR examination.

Discusssion: GBM can cause hypercoagulability due to neoangiogenesis, oncogenic mutation, and chronic coagulation cascade activity. In addition, severe infection and inflammation contribute to the development of DVT, as found in patients with severe COVID-19. In hospitalized patients with COVID-19, the prevalence of DVT is high and usually has a poor outcome. The term COVID-19 associated coagulopathy (CAC) is used to describe changes in coagulation in patients infected with COVID-19.

Conclusion: Increased risk of DVT in GBM and COVID-19 is because of hypercoagulability and coagulopathy due to tumor cells and SARS-CoV-2 virus.

Keywords: glioblastoma, DVT, COVID-19

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References

1. Hanif F, Muzaffar K, Perveen K, Malhi SM, Simjee SU. Glioblastoma Multiforme: A Review of its Epidemiology and Pathogenesis through Clinical Presentation and Treatment. Asian Pac J Cancer Prev. 2017;18(1):3-9.
2. Silantyev AS, Falzone L, Libra M, Gurina OL, Kardashova KS, Nikolouzakis TK, et al. Current and Future Trends on Diagnosis and Prognosis of Glioblastoma: From Mollecular Biology to Proteomics. Cells. 2019;8(8):863.
3. Navone SE, Guarnaccia L, Locatelli M, Rampini P, Caroli M, La Verde N, et al. Significance and Prognostic Value of the Coagulation Profile in Patients with Glioblastoma: Implications for Personalized Therapy. World Neurosurg. 2019;121:621–9.
4. Ren B, Yan F, Deng Z, Zhang S, Xiao L, Wu M, et al. Extremely High Incidence of Lower Extremity Deep Venous Thrombosis in 48 Patients with Severe COVID-19 in Wuhan. Circulation. 2020;142(2):181-183.
5. Khan IH, Savarimuthu S, Leung MST, Harky A. The need to manage the risk of thromboembolism in COVID-19 patients. J Vasc Surg. 2020;(20):31157-5.
6. Pinggera D, Kerschbaumer J, Innerhofer N, Woehrer A, Freyschlag CF, Thomé C. Disseminated Intravascular Coagulation in Secondary Glioblastoma due to Excessive Intraoperative Bleeding: Case Report and Review of the Literature. World Neurosurg. 2016;90:702.e7-11.
7. Stone J, Hangge P, Albadawi H, Wallace A, Shamoun F, Knuttien MG, et al. Deep vein thrombosis: Pathogenesis, diagnosis, and medical management. Cardiovasc Diagn Ther. 2017;7(Suppl 3):S276–84.
8. Modi S, Deisler R, Gozel K, Reicks P, Irwin E, Brunsvold M, et al. Wells criteria for DVT is a reliableclinical tool to assess the risk of deep venous thrombosis in trauma. World J Emerg Surg. 2016;11:24.
9. Mandoj C, Tomao L, Conti L. Coagulation in Brain Tumors: Biological Basis and Clinical Implications. Front Neurol. 2019;10(181):1–7.
10. Zhang L, Feng X, Zhang D, Jiang C, Mei H, Wang J, et al. Deep Vein Thrombosis in Hospitalized Patients with Coronavirus Disease 2019 (COVID-19) in Wuhan, China: Prevalence, Risk Factors, and Outcome. Circulation. 2020;142(2):114-28.
11. Connors JM, Levy JH. COVID-19 and its implications for thrombosis and anticoagulation. Blood. 2020;135(23):2033–40.
12. Divani AA, Andalib S, Napoli M Di, Lattanzi S, Hussain MS, Biller J, et al. Coronavirus Disease 2019 and Stroke: Clinical Manifestations and Pathophysiological Insights. J Stroke Cerebrovasc Dis. 2020;29(8):1–12.
13. Price LC, McCabe C, Garfield B, Wort SJ. Thrombosis and COVID-19 pneumonia: the clot thickens! Eur Respir J. 2020.

Additional Files

Published

2020-08-28

How to Cite

1.
Tugasworo D, Kurnianto A, Retnaningsih R, Andhitara Y, Ardhini R, Priambada D, Daynuri D. Glioblastoma dengan Deep Vein Thrombosis pada pasien COVID-19: Sebuah Laporan Kasus. Medica Hospitalia J. Clin. Med. [Internet]. 2020 Aug. 28 [cited 2024 Jul. 20];7(1A):181-8. Available from: https://medicahospitalia.rskariadi.co.id/medicahospitalia/index.php/mh/article/view/468

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