Korean J Leg Med.  2025 Feb;49(1):16-20. 10.7580/kjlm.2025.49.1.16.

Fatal Pulmonary Embolism Due to Deep Vein Thrombosis after Severe Acute Respiratory Syndrome Coronavirus 2 Infection

• Ha B
• Na JY
• Kim MJ

• KMID: 2565337
• DOI: http://doi.org/10.7580/kjlm.2025.49.1.16

Abstract

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection contribute to platelet activation and thrombus formation. Severe coronavirus disease 2019 (COVID-19) is characterized by an increased risk of thromboembolic events that can lead to adverse outcomes in patients with severe disease manifestations. We present the case of a 41-year-old man who died from a pulmonary embolism and review the connection between SARS-CoV-2 infection, increased platelet counts, and the resulting fatal thrombosis. Total knee replacement surgery was performed and the patient was able to ambulate for a few days postoperatively. The platelet count exceeded the upper limit between postoperative days six and nine, reaching 708,000/μL on day 20. SARS-CoV-2 was confirmed 14 days after surgery, and the patient died 23 days after surgery while hospitalized. Autopsy revealed a fatal pulmonary embolism and deep vein thrombosis. If blood clots are caused by increased platelet counts due to COVID-19, it is essential to understand this relationship and prepare for complications that may arise after infection. Several recent studies have shown a link between COVID-19 and coagulation. We propose several considerations for autopsies of unexpected fatal pulmonary embolism during the SARS-CoV-2 endemic period.

Keyword

SARS-CoV-2; COVID-19; Pulmonary embolism; Thrombocytosis; Autopsy