Lin Jinfeng, Huang Xiaoying, Zhou Weihua, Zhang Suyan, Sun Weiwei, Wang Yadong, Ren Ke, Tian Lijun, Xu Junxian, Cao Zhilong, Pu Zunguo, Han Xudong
Department of Critical Care Medicine, Nantong Third People's Hospital, Nantong University.
Department of Critical Care Medicine, Hai'an County People's Hospital, Nantong, China.
Medicine (Baltimore). 2018 Nov;97(48):e13425. doi: 10.1097/MD.0000000000013425.
Extensive thrombosis in the portal venous system caused by hypereosinophilic syndrome (HES) is rare, and there is no consensus on anticoagulant and thrombolytic treatments for arteriovenous thrombosis caused by HES.
The clinical data of a patient with extensive thrombosis in his portal venous system (superior mesenteric, splenic, hepatic, and portal veins), renal artery thrombosis, and mesenteric thrombosis caused by HES with secondary gastrointestinal bleeding and intestinal necrosis were retrospectively analyzed. Before admission, his eosinophil count increased to 7.47 × 10/L, and HES had been confirmed via bone marrow cytology. The patient experienced fever, cough, abdominal pain, massive hematemesis, and hematochezia that developed in succession. Abdominal computed tomography showed portal vein and superior mesenteric vein thromboses.
Hypereosinophilic syndrome; extensive thrombosis in the portal venous system; acute eosinophil-associated pneumonia; gastrointestinal bleeding; intestinal necrosis.
The patient was first treated with methylprednisolone, plasma exchange/hemofiltration, and single or combined use of unfractionated heparin and argatroban for anticoagulation. He was also administered alteplase and urokinase, successively, for thrombolytic treatment. Once the thromboses finally disappeared, the patient underwent surgery to excise a necrotic intestinal canal.
The thromboses disappeared with these treatments, and the patient recovered after the necrotic intestinal canal was excised.
The clinical manifestations of HES are complex and varied, and this condition can cause severe and extensive arteriovenous thrombosis. Anticoagulation therapy and thrombolysis are necessary interventions, and appear to be safe and effective.
嗜酸性粒细胞增多综合征（HES）导致的门静脉系统广泛血栓形成较为罕见，对于HES所致动静脉血栓的抗凝和溶栓治疗尚无共识。
回顾性分析了一名因HES导致门静脉系统广泛血栓形成（肠系膜上静脉、脾静脉、肝静脉和门静脉）、肾动脉血栓形成及肠系膜血栓形成，并继发胃肠道出血和肠坏死的患者的临床资料。入院前，其嗜酸性粒细胞计数增至7.47×10/L，骨髓细胞学检查确诊为HES。患者相继出现发热、咳嗽、腹痛、大量呕血和便血。腹部计算机断层扫描显示门静脉和肠系膜上静脉血栓形成。
嗜酸性粒细胞增多综合征；门静脉系统广泛血栓形成；急性嗜酸性粒细胞相关性肺炎；胃肠道出血；肠坏死。
患者首先接受甲泼尼龙、血浆置换/血液滤过治疗，并单独或联合使用普通肝素和阿加曲班进行抗凝治疗。还先后给予阿替普酶和尿激酶进行溶栓治疗。血栓最终消失后，患者接受手术切除坏死肠管。
经这些治疗血栓消失，切除坏死肠管后患者康复。
HES的临床表现复杂多样，可导致严重且广泛的动静脉血栓形成。抗凝治疗和溶栓是必要的干预措施，且似乎安全有效。
