Embolizing Massive Right Atrial Thrombus in a HIV-Infected Patient.

Piruthiviraj Natarajan,Theingi Tiffany Win,Fowrooz Joolhar,Everardo Cobos,Sudhagar Thangarasu,Ayham Aboeed

doi:10.1177/2324709618802871

Piruthiviraj Natarajan, Theingi Tiffany Win + Show 4 more

Open Access

https://doi.org/10.1177/2324709618802871

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Abstract

The risk of thromboembolism is increased when associated with the human immunodeficiency viral (HIV) infection. Various factors are involved in promoting thrombosis, and the presence of a patent foramen ovale augments the potential for a paradoxical embolism. We describe the case of a 56-year-old man receiving antiretroviral therapy with features of right heart failure and pulmonary embolism. Due to the high incidence of life-threatening thromboembolism in the HIV-infected group, the need for long-term anticoagulation has to be evaluated.

Highlights

The thrombotic risk is increased by 40% in people infected with human immunodeficiency virus (HIV).[1]
Antiretroviral protease inhibitors were recognized to possibly affect the thrombotic factors synthesized in liver promoting thrombosis.[4]
A patent foramen ovale (PFO) increases the risk of recurrent stroke, and the closure of the atrial septal defect is effective in reducing the stroke risk.[6]

Summary

Introduction

The thrombotic risk is increased by 40% in people infected with human immunodeficiency virus (HIV).[1]. A 56-year-old man, HIV serology positive for 8 years, presented to the emergency department with progressive worsening of shortness of breath for 2 days. The latest cluster definition (CD4) cells count was 804 cells/μL, and he received antiretroviral therapy Genvoya (elvitegravir/cobicistat/emtricitabine/tenofovir alafenamide) He was previously diagnosed with asthma and positive IgG (immunoglobulin G) serology for hepatitis C virus (HCV). The patient had jugular venous distension and tachypnoea with bilateral basal crackles heard on auscultation He had bilateral pitting pedal edema (grade 2) reaching the bilateral tibial tuberosity. The protruded freely mobile, small linear segment of the echo density measured 10 × 3 mm on the left atrial side He received low-molecular-weight heparin (enoxaparin) 1 mg/kg to prevent further thrombosis. Goals of care were discussed with the family, and he was transitioned from critical care to long-term care facility

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