CASE REPORT article
Front. Med.
Sec. Nephrology
This article is part of the Research TopicCritical Cases in Clinical NephrologyView all 7 articles
Spontaneous Inferior Epigastric Artery Hemorrhage in a COVID-19 Patient with Membranous Nephropathy on Anticoagulant Therapy: A Case Report
Provisionally accepted
- Zibo Central Hospital, Shandong, China
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Background: The management of Coronavirus disease 2019 (COVID-19) is complicated by coagulopathies that increase both thrombotic and hemorrhagic risks, particularly in patients with comorbidities such as membranous nephropathy (MN) who require anticoagulation. Spontaneous inferior epigastric artery (IEA) hemorrhage is a rare but life-threatening complication in this setting. Case Presentation: A 63-year-old woman with PLA2RM-type phospholipase A2 receptor (PLA2R)-positive MN was admitted for COVID-19 pneumonia and acute respiratory distress syndrome (ARDS). Despite prophylactic anticoagulation with dalteparin, her respiratory status deteriorated, requiring intensive care. On day 24, she developed sudden hemorrhagic shock due to a rectus sheath hematoma from spontaneous IEA rupture, confirmed by imaging and surgical exploration. The hemorrhage was managed with ligation, transfusion, and discontinuation of anticoagulation. Her recovery was marked by resolution of pulmonary and hemorrhagic complications by day 46, and three-month follow-up showed no recurrence of bleeding or thrombotic events. Conclusion: This case highlights the critical balance between thromboprophylaxis and bleeding risk in COVID-19 patients with MN. It underscores the need for individualized anticoagulation strategies, pharmacodynamic monitoring, and multidisciplinary decision-making to mitigate risks in this high-risk population. The interplay of COVID-19-induced coagulopathy, renal impairment, and immunosuppressive therapy amplifies both thrombotic and hemorrhagic tendencies, necessitating extreme vigilance in clinical management.
Keywords: Anticoagulant therapy, COVID-19, Inferior epigastric artery, Membranous nephropathy, Spontaneous Hemorrhage
Received: 20 Oct 2025; Accepted: 30 Nov 2025.
Copyright: © 2025 Hou, Xu, Wang, Zhang, Yu, Zhu, Song, Zhang and Wang. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Kai Wang
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