Abstract
BackgroundAcquired thrombophilia is a potential sequela of malignancy, chronic inflammation, and conditions characterized by severe protein deficiency (for example, nephrotic syndrome, protein-losing enteropathy). As such, venous thrombosis is often a feature, and occasionally a presenting sign, of systemic disease. Ménétrier’s disease is a rare hyperplastic gastropathy that may lead to gastrointestinal protein loss and hypoalbuminemia. To date, reports of venous thrombosis associated with Ménétrier’s disease are exceedingly scarce.Case presentationWe report the case of a 40-year-old white man who presented with unprovoked deep venous thrombosis, pulmonary embolism, and renal vein thrombosis. Upon receiving therapeutic anticoagulation, he developed severe gastrointestinal bleeding, and endoscopic evaluation led to a diagnosis of Ménétrier’s disease. A laboratory workup revealed deficiency of protein C, protein S, and antithrombin III, as well as markedly elevated levels of factor VIII. He was determined to have an acquired thrombophilia as a direct result of Ménétrier’s disease.ConclusionsThis case describes an acquired thrombophilic state in a patient with Ménétrier’s disease and profound hypoalbuminemia. Although this association is rarely described, we discuss the probable mechanisms leading to our patient’s thrombosis. Specifically, we posit that his gastrointestinal protein loss led to a deficiency of several anticoagulant proteins and a compensatory elevation in factor VIII, as occurs in nephrotic syndrome and inflammatory bowel disease. Of note, this patient’s recurrent venous thrombosis was the initial clinical sign of his gastrointestinal pathology.
Highlights
Acquired thrombophilia is a potential sequela of malignancy, chronic inflammation, and conditions characterized by severe protein deficiency
Thrombophilia refers to any condition that increases the risk of venous and/or arterial thrombosis, most commonly deep venous thrombosis (DVT) and pulmonary embolism (PE)
Case presentation A 40-year-old white man presented to an outside emergency department in June 2018 with sudden-onset right calf pain, swelling, and redness. He had a history of juvenile polyposis syndrome, for which he underwent a partial colectomy as a child, and alcohol use disorder
Summary
We present the case of a 40-year-old man who developed acquired thrombophilia secondary to a protein-losing gastropathy This case highlights an extremely rare cause of thrombophilia, made more notable by the fact that unprovoked venous thrombosis was the initial disease manifestation. Our patient’s case was complicated by the development of GI bleeding when therapeutic anticoagulation was initiated His simultaneous bleeding and hypercoagulability presented a distinct clinical challenge, which necessitated in-patient observation and unfractionated heparin therapy. The strengths of this case report include its novelty; we describe a rare disease process involving the GI system, with even more unusual hematologic manifestations. At the discretion of the treating clinicians, these tests were withheld because they were felt to be low yield and unlikely to influence management
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