Abstract
BackgroundPsoriasis is no longer viewed as an isolated dermatological ailment and instead is considered a systemic disease. The extension of this spectrum has heightened the known risk of morbidity and mortality due to the involvement of cardiovascular system and the risk of venous thrombosis. A number of cases have reported the increased occurrence of deep vein thrombosis and pulmonary embolism in the background of psoriasis, however portal vein thrombosis has not been reported to date. We report an index case of chronic portal vein thrombosis in a diagnosed patient with psoriasis.Case presentationA 67-year-old South-Asian female previously diagnosed and treated for psoriasis presented with a four month history of abdominal pain associated with abdominal distension. Clinical examination revealed an enlarged spleen and free fluid in the abdomen. Imaging with ultrasonography and computed tomography of the abdomen revealed features compatible with chronic portal vein thrombosis with cavernous transformation.ConclusionThis case highlights the importance of having clinical awareness of occurrence of thrombosis in patients with psoriasis. Typical symptoms favoring thrombosis should prompt thorough investigation to exclude this rare yet possible complication in patients with psoriasis, including that of portal vein thrombosis. Prophylaxis with anticoagulation still lacks strength of evidence to be justified in psoriasis. The exact pathogenesis of venous thromboembolism in psoriasis is still unexplained and further studies are needed to clarify the causal association.
Highlights
Psoriasis is no longer viewed as an isolated dermatological ailment and instead is considered a systemic disease
This case highlights the importance of having clinical awareness of occurrence of thrombosis in patients with psoriasis
We report a unique case of portal vein thrombosis in a patient with psoriasis
Summary
Though the pathogenesis is not fully understood, the risk of thrombosis in patients with psoriasis should be appreciated. Clinicians should be wary of the different ways in which venous thromboembolism can present in psoriasis and should have a high index of clinical suspicion when patients present with typical symptoms. Screening patients with psoriasis for additional risk factors that promote thrombosis should be considered. We report this as an index case of portal vein thrombosis in a patient with psoriasis with anti-phospholipid syndrome. Consent Written informed consent was obtained from the patient for publication of this case report. Copies of the written consent is available for review by the Editor-in-Chief of this journal. SJ helped substantially in literature review and drafting the manuscript. All authors read and approved the final manuscript
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