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Publication Date
2024
Keywords
oregon, oregon gme, ppmc, oaa 2024
Disciplines
Cardiology | Gastroenterology | Medical Education
Abstract
Introduction: Patients with inflammatory bowel disease (IBD) have an estimated three-fold higher risk of venous thromboembolism (VTE) compared to the general population. We present a case of a 19-year-old female with phlegmasia curelea dolens and massive pulmonary embolism in the setting of severe ulcerative colitis. Case Presentation : • 19-year-old female with iron deficiency anemia and three-month history of hematochezia, recently started on oral contraceptive pills. • Presented with acute left lower extremity pain, swelling, and cyanosis concerning for phlegmasia curulea dolens and compartment syndrome. • Underwent emergent thrombectomy, venoplasty, and fasciotomies. • Post-operatively, course complicated by obstructive shock and severe right heart failure due to massive bilateral pulmonary embolism requiring VA ECMO, heparin, and right sided aspiration thrombectomy (Figure 5). • Patient had a positive lupus anticoagulant and mildly elevated anti cardiolipin antibody (44.1) suggestive of possible antiphospholipid syndrome (APS), otherwise work up for hypercoagulability was negative (Figure 1). No family history of VTE or thrombophilia. • As she developed worsening hematochezia and abdominal pain, the patient underwent a colonoscopy which showed severe ulcerative pancolitis. • Patient received IV steroids and induction with Infliximab. Conclusions: • We describe a case of a patient who presented with massive thrombosis in the setting of having three risk factors for VTE: severe IBD, OCP use, and possible APS. • IBD is a well-recognized risk factor for VTE. Between 60-80% of IBD patients have active disease when they develop VTE, and studies suggest there is a six-fold higher risk for VTE in patients hospitalized for IBD flares than those that have non-hospitalized flares. • General recommendation is patients with VTE who have coexisting IBD do not need testing for hereditary or acquired hypercoagulable states. • Consideration of anticoagulant thromboprophylaxis is a vital component in the management of IBD patients (Table 2). • With her known history of iron deficiency anemia and hematochezia, IBD was likely a missed diagnosis. • We conclude IBD should be considered in the differential of venous thromboembolism.
Area of Special Interest
Cardiovascular (Heart)
Area of Special Interest
Digestive Health
Specialty/Research Institute
Graduate Medical Education
Specialty/Research Institute
Cardiology
Specialty/Research Institute
Gastroenterology
