Recurrent abdominal and lower limb venous thrombosis due to inherent protein-C and protein-S deficiency

Authors

  • Naren Polavarapu Department of General Medicine, Sri Ramachandra Institute of Higher Education and Research, Porur, Chennai, Tamil Nadu, India
  • Senthil Narayanasamy Department of General Medicine, Sri Ramachandra Institute of Higher Education and Research, Porur, Chennai, Tamil Nadu, India
  • Naveen Arunachalam Subramanian Department of General Medicine, Sri Ramachandra Institute of Higher Education and Research, Porur, Chennai, Tamil Nadu, India

DOI:

https://doi.org/10.18203/2320-6012.ijrms20193653

Keywords:

Protein-C, protein-S, Venous thrombosis, Portal vein thrombosis

Abstract

Protein-C and protein-S deficiency is associated with a hypercoagulable state which usually presents with recurrent venous thrombosis as a common complication. But extensive thrombosis involving all the major abdominal and lower limb veins is quite rare. Here, we report a case of a 27-year-old woman presented with engorged veins all over abdomen and chest since 20 days. Clinical examination revealed signs suggestive of portal venous hypertension with moderate splenomegaly. Protein-C and protein-S levels were found to be low. Portal venous doppler ultrasound and CT-venogram revealed chronic thrombosis of portal vein, inferior vena cava, bilateral iliac and femoral veins with extensive collaterals formation and partial thrombosis in collaterals as well.  The patient was successfully managed with anti-coagulating agent (acenocoumarol) and has been maintained on regular follow-up to avoid reoccurrence of thrombosis.

References

Nachman RL, Silverstein R. Hypercoagulable states. Annals of Internal Medicine. 1993;119:819-27.

Qi X, De Stefano V, Wang J, Bai M, Yang Z, Han G, et al. Prevalence of inherited antithrombin, protein C, and protein S deficiencies in portal vein system thrombosis and B udd‐C hiari syndrome: A systematic review and meta‐analysis of observational studies. Journal of gastroenterology and hepatology 2013;28(3):432-42.

Hotoleanu C. Genetic risk factors in venous thromboembolism. Thrombosis and Embolism: from Research to Clinical Practice: Springer; 2017:906;253-72.

Cho Y, Kwon T, Ahn J, Kang G, Han M, Kim Y, et al. Protein C and/or S deficiency presenting as peripheral arterial insufficiency. The British J radiol. 2005;78:601-5.

Doganay S, Sonmezgoz F, Sen Y, Kocakoc E. Deep vein thrombosis associated with protein C and protein S deficiency: An unusual cause of acute abdomen. J Clinical Ultrasound. 2011;39(5):287-9.

Mondal R, Nandi M, Dhibar T. Protein C and protein s deficiency presenting as deep venous thrombosis. Indian pediatr. 2010;47(2):188-9.

Deshpande S, Patil S, Pendse M, Kashyap P, Dave D. Portal vein thrombosis with protein CS deficiency in a non-cirrhotic patient. International Journal of Research in Medical Sciences 2016;4(11):5061.

Rodríguez-Leal GA, Morán S, Corona-Cedillo R, Brom-Valladares R. Portal vein thrombosis with protein CS deficiency in a non-cirrhotic patient. World J hepatol. 2014;6(7):532.

Downloads

Published

2019-08-27

How to Cite

Polavarapu, N., Narayanasamy, S., & Subramanian, N. A. (2019). Recurrent abdominal and lower limb venous thrombosis due to inherent protein-C and protein-S deficiency. International Journal of Research in Medical Sciences, 7(9), 3550–3552. https://doi.org/10.18203/2320-6012.ijrms20193653

Issue

Section

Case Reports