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Silvia Spoto,1 Emanuele Valeriani,1 Elisabetta Riva,2 Marina De Cesaris,3 Giuseppe Tonini,4 Bruno Vincenzi,5 Luciana Locorriere,1 Giuseppina Beretta Anguissola,1 Angelo Lauria Pantano,1 Elisa Brando,1 Sebastiano Costantino,1 Massimo Ciccozzi,5 Silvia Angeletti3 1Diagnostic and Therapeutic Medicine Department, University Campus Bio-Medico of Rome, Rome, Italy; 2Unit of Virology, University Campus Bio-Medico of Rome, Rome, Italy; 3Unit of Clinical Laboratory Science, University Campus Bio-Medico of Rome, Rome, Italy; 4Department of Medical Oncology, University Campus Bio-Medico of Rome, Rome, Italy; 5Unit of Medical Statistics and Molecular Epidemiology, University Campus Bio-Medico of Rome, Rome, ItalyCorrespondence: Silvia SpotoDiagnostic and Therapeutic Medicine Department, University Campus Bio-Medico of Rome, Rome, ItalyTel +3906225411461Email s.spoto@unicampus.itIntroduction: Coronavirus disease 19 (COVID-19), due to severe acute respiratory syndrome-coronavirus 2 (SARS-CoV2), comprises a broad spectrum of clinical presentation ranging from flu-like syndrome to organ failure. The risk of coinfections is high and responsible for a worse prognosis, mainly in the case of bacterial involvement and in the presence of particular comorbidity. We present the clinical, laboratory, radiologic characteristic along with therapeutic management of a patient with COVID-19 and Staphylococcus aureus coinfection.Case Presentation: A 55-year-old Caucasian woman was admitted to our hospital due to a two-day history of fever and acute dyspnea with severe respiratory failure worsened after the administration of atezolizumab and nab-paclitaxel. Her medical history comprehended a triple negative, BRCA1-related, PD-L1 positive right breast cancer with multiple bone metastasis, causing bone marrow infiltration-related severe pancytopenia. Her physical examination revealed scattered wheezes, rales, and bilateral dry crackles in the middle and lower lung fields and lower limb paresis. The body mass index was 30 kg/m2 and arterial blood gas evaluation revealed a stage III acute respiratory distress syndrome. Microbiological specimens revealed a Staphylococcus aureus positivity from endotracheal aspirate. The chest computed tomography (CT) scan showed the presence of large areas of parenchymal consolidation and aerial bronchogram, bilateral “ground glass” areas reaching the highest extension on the upper and middle zones. The high clinical and radiological suspicion of COVID-19 along with the negative result of nasopharyngeal specimen make necessary an endotracheal aspirate resulting positive for SARS-CoV2. Patient started an antimicrobial treatment and lopinavir-ritonavir plus hydroxychloroquine but, unfortunately, died five days after hospital admission.Conclusion: The high risk of mortality of our patient was due to viral-bacterial coinfection, advanced cancer status with active immunotherapy. This case highlights the need for a prompt clinical, laboratory, and radiological evaluation to allow a correct diagnosis and start a specific therapy.Keywords: COVID-19, SARS-CoV2, pneumonia, computed tomography, Staphylococcus aureus, cancer patient

Emanuele Valeriani,1 Nicoletta Riva,2 Marcello Di Nisio,1 Walter Ageno3 1Department of Medicine and Ageing Sciences, University G. D’Annunzio, Chieti-Pescara, Italy; 2Department of Pathology, Faculty of Medicine and Surgery, University of Malta, Msida, Malta; 3Department of Medicine and Surgery, University of Insubria, Varese, ItalyCorrespondence: Nicoletta RivaDepartment of Pathology, Faculty of Medicine and Surgery, University of Malta, Msida, MSD 2080, MaltaTel +356 2545 2518Fax +356 2545 0000Email nico.riva@hotmail.itAbstract: Splanchnic vein thrombosis (SVT) including portal, mesenteric, splenic vein thrombosis and the Budd-Chiari syndrome, is a manifestation of unusual site venous thromboembolism. SVT presents with a lower incidence than deep vein thrombosis of the lower limbs and pulmonary embolism, with portal vein thrombosis and Budd-Chiari syndrome being respectively the most and the least common presentations of SVT. SVT is classified as provoked if secondary to a local or systemic risk factor, or unprovoked if the causative trigger cannot be identified. Diagnostic evaluation is often affected by the lack of specificity of clinical manifestations: the presence of one or more risk factors in a patient with a high clinical suspicion may suggest the execution of diagnostic tests. Doppler ultrasonography represents the first line diagnostic tool because of its accuracy and wide availability. Further investigations, such as computed tomography and magnetic resonance angiography, should be executed in case of suspected thrombosis of the mesenteric veins, suspicion of SVT-related complications, or to complete information after Doppler ultrasonography. Once SVT diagnosis is established, a careful patient evaluation should be performed in order to assess the risks and benefits of the anticoagulant therapy and to drive the optimal treatment intensity. Due to the low quality and large heterogeneity of published data, guidance documents and expert opinion could direct therapeutic decision, suggesting which patients to treat, which anticoagulant to use and the duration of treatment.Keywords: Budd-Chiari syndrome, mesenteric vein thrombosis, portal vein thrombosis, splanchnic vein thrombosis, splenic vein thrombosis