Miao Jing, Naik Geetha, Muddana Sivakumar, Li Xiaohuan, Bhimasani Supriya, Mitchell Ronald Alvin, Alaie Dariush, Petrillo Richard L
Department of Internal Medicine, Montefiore Mount Vernon Hospital, Mount Vernon, NY, USA.
Am J Case Rep. 2017 Mar 28;18:313-316. doi: 10.12659/ajcr.902391.
BACKGROUND Deep vein thrombosis (DVT) is a type of venous thromboembolism with diverse clinical and environmental risk factors. Very few cases of DVT with multiple high risk factors have been reported. Here, we report an uncommon DVT case with multiple etiological causes, including appendicitis/appendectomy, morbid obesity, immobilization, positive phosphatidylserine IgG, and heterozygous factor V Leiden mutation. CASE REPORT A 43-year-old female was brought to the emergency room because of 2-week history of pain and swelling and ultrasound revealing evidence of DVT in the right leg. One month ago, she underwent an exploratory laparotomy because of subacute appendicitis. After surgery, the patient stayed at home in bed with very limited activity. She did not have a cough, hemoptysis, chest pain, or shortness of breath. She was morbidly obese, and had a past medical history of diabetes, hypertension, and hyperlipidemia. A full coagulation workup was completed, including Protein C, Protein S, and antiphospholipid antibody, as well as factor V and prothrombin gene mutation screen. Her D-dimer was positive. Computed tomography (CT) angiography of the lungs ruled out major emboli but was unable to rule out minor emboli. A heterozygous factor V Leiden R506Q mutation was detected. Of interest was a significantly positive phosphatidylserine IgG with a value of over 42. She was started with enoxaparin (120 mg, twice a day), and warfarin was added on day 2 when pulmonary embolism was ruled out by CT angiography. The International Normalized Ratio (INR) was monitored daily to adjust warfarin dose. CONCLUSIONS Multiple etiological factors present in this patient may have contributed to her lower-limb DVT, including appendicitis/appendectomy, morbid obesity, immobilization, positive phosphatidylserine IgG, and factor V Leiden mutation. Therefore, it is important to follow the complete workup for hypercoagulable states. This can help with diagnosis and therapy, and also give insight into the pathogenicity, which can help with prevention of recurrence and severe complications of DVT.
深静脉血栓形成（DVT）是一种静脉血栓栓塞症，具有多种临床和环境风险因素。很少有关于具有多种高危因素的DVT病例报道。在此，我们报告一例罕见的具有多种病因的DVT病例，病因包括阑尾炎/阑尾切除术、病态肥胖、制动、磷脂酰丝氨酸IgG阳性以及杂合子因子V莱顿突变。
一名43岁女性因右下肢疼痛肿胀2周且超声检查显示有DVT迹象而被送往急诊室。1个月前，她因亚急性阑尾炎接受了剖腹探查术。术后，患者居家卧床，活动非常有限。她没有咳嗽、咯血、胸痛或气短症状。她病态肥胖，既往有糖尿病、高血压和高脂血症病史。完成了全面的凝血检查，包括蛋白C、蛋白S和抗磷脂抗体，以及因子V和凝血酶原基因突变筛查。她的D - 二聚体呈阳性。肺部计算机断层扫描（CT）血管造影排除了主要栓子，但无法排除微小栓子。检测到杂合子因子V莱顿R506Q突变。有趣的是，磷脂酰丝氨酸IgG显著阳性，值超过42。她开始使用依诺肝素（120毫克，每日两次），在CT血管造影排除肺栓塞后第2天加用华法林。每天监测国际标准化比值（INR）以调整华法林剂量。
该患者存在的多种病因可能导致了她的下肢DVT，包括阑尾炎/阑尾切除术、病态肥胖、制动、磷脂酰丝氨酸IgG阳性以及因子V莱顿突变。因此，对高凝状态进行全面检查很重要。这有助于诊断和治疗，也能深入了解发病机制，有助于预防DVT的复发和严重并发症。
