Abstract
Pulmonary embolism (PE) with isolated homocysteinemia is a rare disease. The diagnosis demands a proper clinical workup. Timely diagnosis can prevent complications and provide a better quality of life for the patient. We present a young man with homocysteinemia with deep vein thrombosis (DVT), pulmonary embolism, and normal vitamin B12 and folate levels despite being treated with rivaroxaban.
Highlights
An elevated level of homocysteine in the body is known as homocysteinemia or hyperhomocysteinemia
Nonalcoholic young man diagnosed with homocysteinemia with deep vein thrombosis (DVT), pulmonary embolism (PE), and right ventricle (RV) dilation with normal vitamin B12 and folate levels
Homocysteine levels in the blood are usually elevated in patients with folate deficiency because folate is required for the remethylation of homocysteine to methionine
Summary
An elevated level of homocysteine in the body is known as homocysteinemia or hyperhomocysteinemia. The patient was admitted and appropriately evaluated for DVT, including Doppler ultrasound and blood work He was started on anticoagulation therapy with oral rivaroxaban. Five days after admission and receiving an anticoagulant, he developed dyspnea and hyperventilation in the morning His arterial blood gas test showed respiratory alkalosis. Notable results from the laboratory workup and coagulation profile are presented in Table 2 and Table 3, respectively His homocysteine level was greater than 65 μmol/L. Prothrombin time Activated partial thromboplastin time 17 sec 34 sec TABLE 3: Coagulation profile of the patient at the time of presentation. His dilated RV diameter was 27.9 mm.
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