At just 38, he did not fit the description of people at high risk of complications from the new coronavirus.
"He had mild pulmonary symptoms that he only had at home," says Dr. Sean Wengerter, a vascular surgeon in Pomona, New York. "He had been diagnosed with an emergency room and it went well at home. He just had a little cough."
Until one of Covid-19's surprising effects kicked in.
"Then he just woke up with both legs numb and cold and so weak he couldn't walk," says Wengerter, who is the divisional director of vascular surgery at Westchester Medical Center Health & # 39; Good Samaritan Hospital.
Coronavirus can cause blood clots
This relatively young man had an aortic occlusion – a large blood clot in the body's main artery, just above where it splits into two parts to run into each leg. No blood entered the arteries, and the bones were starved.
It is an extremely dangerous development that can kill between 20% and 50% of patients, Wengerter said. "It doesn't usually happen to a 38-year-old," he told CNN.
Quick diagnosis and a surgical procedure to excrete the arteries and eject the blood clot using a catheter saved the patient. "We had two surgeons working with him at the same time," Wengerter said.
Doctors treating patients with coronavirus see a variety of weird and scary syndromes, including blood clots of all sizes in the body, kidney failure, heart inflammation and immune complications.
"One thing that is both curious and evolving and frustrating is that this disease manifests itself in so many different ways," said Dr. Scott Brakenridge, an assistant professor in the team of emergency care surgery at the University of Florida College of Medicine.
It can also cause organ system failure in several systems
"In some cases, it has serious effects on the patient's breathing ability, and in others it appears to be associated with the development of multiple system organ failure – when all your organs are closing. And now it is associated with immune effects in children."
While the new coronavirus is designated as an airway virus, it is clear that it affects some people in the body. The most obvious symptoms of infection are classic respiratory symptoms: fever, pneumonia and acute respiratory syndrome.
But the virus also seems to attack some organs directly. One of the most disturbing is its attack on the blood vessels in the blood vessels, which in turn causes unnatural blood clotting.
"Covid, the virus, seems to create a local inflammatory response that leads to some of these thrombotic events," Wengerter said. "This happens because of the virus's direct effect on the arteries themselves."
Other teams of doctors have reported unusual strokes in younger patients, in addition to pulmonary embolisms, the medical name for blood clots in the lungs.
Pathologists also find small blood clots in the smallest vessels, says Dr. Oren Friedman, who has taken care of Covid-19 patients in the intensive care unit at Cedars-Sinai Medical Center in Los Angeles.
"There's no debate – the virus seems to affect thrombosis and seems to affect your blood vessels directly," Friedman told CNN. And that means it affects the whole body.
"Obviously, every single organ in your body gets fed by blood vessels, so if the virus affects your blood vessels, you can get organ damage," he said.
"It's a very confusing picture. It will take time to understand," Brakenridge said.
It can cause a child's immune system to overreact
"In some cases, children have shock and some have features of Kawasaki disease, while others may have signs of cytokine storm. In some geographical areas there has been an uptick in cases of Kawasaki disease in children who do not have shock , "Boston Children & # 39; s Rheumatologist, Dr. Mary Beth Son, sa. Kawasaki disease involves inflammation of the walls of medium arteries and can damage the heart.
It may be caused by an immune system response known as a cytokine storm, doctors say.
"Your immune system is overreacting to the virus, and because these are inflammatory diseases, this overreaction can cause a Kawasaki-like disease," Dr. Glenn Budnick, a pediatrician in Pomona, New Jersey, told CNN Newsroom Saturday.
"It is even possible that the antibodies that children make against SARS-CoV2 create an immune response in the body. Nobody knows," said Dr. Jane Newburger, a cardiologist in the Boston Children's panel and an expert on Kawasaki disease.
Cytokine storms can also cause some of the lung damage and unusual blood clots seen in adult patients, doctors said.
"There is other evidence that the virus does not really give a strong immune response and that it actually suppresses the immune system," Brakenridge said. This will allow the virus to attack organs more directly.
Dr. Zheng Zhang and colleagues at Shenzhen Third People's Hospital in Shenzhen, China analyzed samples of immune cells retrieved 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 patients. patients. Diseased patients also had high levels of proliferating T cells, another type of immune cell.
However, patients with the most severe symptoms had lower numbers of CD8 T cells, which directly kill virus-infected cells.
Doctors say they feel that different treatments can help control symptoms. Blood thinners can help control the unusual blood clots, while immune blockers can help control the cytokine storm.
It can lead to "heavy toes"
One last symptom that is strange – but less disturbing – is known as "tough toes." Patients report red or purple swelling in the toes.
It's possible the small blood clots associated with Covid-19 are causing it, doctors said.
It's usually not associated with any serious symptoms, Choi said.