Infarction in the Young – A Clinical Case Report

Abstract

Abstract We present the case of a 34-year-old male who suddenly experienced upper right quadrant abdominal pain of medium-high intensity that radiated towards his right lumbar area and right testicle, accompanied by nausea and vomiting. His personal history was significant for having an eye prosthesis implanted when he was three years old, due to structural degradation of undetermined cause in his left eye. He was first seen by a surgeon who recommended an abdominal CT scan and an urology consultation. In the urology clinic, renal and testicular ultrasounds were normal and he was prescribed symptomatic medication. Due to the pain escalating, the patient underwent a contrast CT scan of the abdomen and pelvis that revealed two renal infarction lesions in the middle and inferior thirds of the right kidney. The patient was admitted and anticoagulants and pain medication were started. A full body CT scan did not reveal any other abnormalities. Tumour markers and genetic thrombophilia markers were sent for analysis. He was referred to a nephrology clinic, where he underwent screening for multiple myeloma and vasculitic/autoimmune causes, with negative results. A contrast renal vascular ultrasound of the right kidney identified the obstructions as being in the middle and inferior interlobar veins. Afterwards, the genetic tests revealed three thrombophilic mutations – factor V Leiden positive homozygote, MTHFR C677T and A1298C both positive heterozygote. This might have also been the cause of the childhood ocular surgery. The patient continued anticoagulation with apixaban, with no further significant medical events to this day.