At only 38, it did not fit the description of people at high risk of complications from the new coronavirus.
"He had mild pulmonary symptoms with which he was sitting at home," said Dr. Sean Wengerter, vascular surgeon in Pomona, New York. "He was diagnosed in an emergency care clinic and everything was fine at home. He just had a little cough."
Until one of the surprising effects of Covid-19 comes into play.
"Then he just woke up with his legs numb and cold and so weak he couldn't walk," said Wengerter, division chief of vascular surgery at Good Samaritan Hospital at Westchester Medical Center Health.
Coronavirus can cause blood clots
This relatively young man had an aortic occlusion - a large blood clot in the main artery of the body, just above where it divides into two parts to end up in each leg. Blood did not enter the iliac arteries and his legs were hungry.
It is an extremely dangerous development that can kill between 20% and 50% of patients, said Wengerter. "It usually doesn't happen in a 38-year-old man," he told CNN.
A quick diagnosis and surgery to open the arteries and remove the clot using a catheter saved the patient. "We had two surgeons working on him simultaneously," said Wengerter.
Doctors treating coronavirus patients see a range of strange and scary syndromes, including blood clots of all sizes throughout the body, kidney failure, heart inflammation, and immune complications.
"One thing that is both curious and progressive and frustrating is that this disease manifests in so many different ways," said Dr. Scott Brakenridge, assistant professor on the acute care surgery team at the University of Florida College of Medicine.
It can also cause multi-system organ failure
"In some cases it has serious effects on the patient's ability to breathe, and in others it seems to be associated with the development of multisystem failure - when all of your organs have stopped. And now it is associated to immune effects in children. "
Although the new coronavirus is designated as a respiratory virus, it is clear that it affects some people throughout their body. The most obvious symptoms of infection are the classic respiratory symptoms: fever, pneumonia, and acute respiratory distress syndrome.
But the virus also seems to directly attack certain organs. One of the most disturbing is its attack on the lining of blood vessels, which in turn causes unnatural blood clotting.
"It appears that Covid, the virus, creates a local inflammatory response that leads to some of these thrombotic events," said Wengerter. "This happens due to the direct action of the virus on the arteries themselves."
Other teams of doctors have reported unusual strokes in younger patients, as well as pulmonary embolism, the medical name for blood clots in the lungs.
Pathologists also find tiny blood clots in the smallest vessels, said Dr. Oren Friedman, who cares for Covid-19 patients in the intensive care unit at Cedars-Sinai Medical Center in Los Angeles.
"There is no debate - the virus seems to affect thrombosis and seems to directly affect your blood vessels," Friedman told CNN. And that means it affects the whole body.
"Obviously, every organ in your body is fueled by blood vessels, so if the virus affects your blood vessels, you may have organ damage," he said.
"It's a very confusing picture. It will take time to understand," said Brakenridge.
This could cause an over-reaction of the children's immune system
One of the scariest syndromes that could be linked to Covid-19 is "Pediatric Multisystem Inflammatory Syndrome". New York City is reporting 52 cases, Mayor Bill de Blasio said on Tuesday, and the New York State Department of Health has announced that it is investigating 100 cases.
It is characterized by persistent fever, inflammation, poor function in one or more organs, and other symptoms that resemble shock, according to a panel of pediatricians known as the international collaboration PICU-COVID-19.
"In some cases, the children show shock and some have features of Kawasaki disease, while others may show signs of a cytokine storm. In some geographic areas, there has been a slight increase in cases of Kawasaki disease in children who don't have shock, "Dr. Mary Beth Son, rheumatologist at Boston Children's Hospital, said. Kawasaki disease causes inflammation of the walls of medium-sized arteries and can damage the heart.
This can be caused by an immune system response known as a cytokine storm, according to doctors.
"Your immune system is overreacting to the virus, and since these are inflammatory diseases, this overreaction can cause Kawasaki-like disease," pediatrician Pomona, New Jersey pediatrician Dr. Glenn Budnick said on CNN on Saturday. Newsroom.
"It is even possible that the antibodies that children make against SARS-CoV2 create an immune response in the body. No one knows," said Dr. Jane Newburger, cardiologist at the Boston Children's Panel and specialist in Kawasaki disease .
The cytokine storm can also cause lung damage and unusual blood clotting in adult patients, doctors say.
"There is other evidence that the virus does not really generate a strong immune response and that it actually suppresses the immune system," said Brakenridge. This would allow the virus to attack organs more directly.
A study published Tuesday in the journal Nature Medicine supported both theories.
Dr. Zheng Zhang and colleagues at Shenzhen Third People's Hospital in Shenzhen, China, analyzed immune cell samples from the lungs of nine coronavirus patients and found abnormally high levels of immune cells called macrophages and neutrophils, as well as immune signaling chemicals called cytokines and chemokines in the sickest patients. The sick patients also had high levels of proliferating T cells, another type of immune cell.
But the patients with the most severe symptoms had fewer CD8 T cells, which directly kill cells infected with the virus.
Doctors say they find that various treatments can help control the symptoms. Anticoagulants can help control unusual blood clotting, while immune blockers can help control the cytokine storm.
It can cause Covid toes
A final confusing symptom - but less disturbing - is known as "Covid toes". Patients report red or purple swelling in their toes.
The tiny blood clots associated with Covid-19 may be causing it, doctors say.
"One pattern of COVID toes that people report is red lesions usually on the soles of the feet. It is possible that it is a skin reaction or caused by a small blockage or micro clots in the blood vessels found in the toes" , Cleveland Clinic pneumologist Dr. Humberto Choi said on the clinic's website.
This is generally not associated with severe symptoms, said Choi.
