Pulmonary Embolism Confounded with COVID: Interesting Case Report from India

 Out on PubMed, from clinicians in Chandigarh, India, is this case report:

Pulmonary embolism confounded with COVID-19 suspicion in a catatonic patient presenting to anesthesia for ECT: a case report.

Naik BN, Singh N, Aditya AS, Gupta A, Prabhakar N, Grover S.Braz J Anesthesiol. 2021 Mar 22:S0104-0014(21)00096-8. doi: 10.1016/j.bjane.2021.02.031. Online ahead of print.PMID: 33766683

The abstract is copied below:
Catatonic patients may develop deep vein thrombosis (DVT) and pulmonary embolism (PE) due to prolonged periods of immobility. These life-threatening conditions demand prompt recognition and management. We describe the case of a patient with catatonia who presented to anesthesia for electroconvulsive therapy (ECT) at the outset of the current coronavirus disease 2019 pandemic. She complained of breathing difficulty and was suspected to have COVID-19 infection. On further evaluation, she was found to have DVT and PE and required oxygen therapy and intensive care management. The diagnostic delay in our patient would have probably not occurred, had it not been for the existing pandemic situation.

Keywords: COVID-19; Catatonia; Deep vein thrombosis; Pulmonary embolism.

The pdf is here.


This is an interesting case that is a reminder to keep an open mind about common diagnoses. This patient with catatonia originally reported "difficulty breathing" but the diagnosis of PE was missed and her COVID test was negative. ECT was initiated. Two days after the first ECT she deteriorated and the correct diagnosis of PE was made. She was appropriately assessed and treated, recovered, and apparently successfully completed her course of ECT. The second take home message of this report is that patients with catatonia are at risk for various medical comorbidities, including PE.
ECT providers and ECT anesthesiologists will want to read this case in full, ~10 minutes.

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