Vol 8 No 1

Vol 8 No 1
  • Patrick Manckoundia, Evelyne Franon

    Introduction: The typical clinical picture of COVID-19 is gradually becoming clearer, both in the acute phase and in the long-term. However, new symptoms are gradually being identified. We describe a long-term symptom that has not yet been reported.

    Case description: A 49-year-old man consulted for persistent asthenia. The general practitioner found a fever (39.2°C), and COVID-19 was confirmed by the polymerase chain reaction test. Further symptoms appeared, notably thick, white, painless tracheal hypersecretion for 3 months before diminishing, without disappearing.

    Conclusion: Non-inflammatory tracheal hypersecretion, not yet reported in COVID-19, may be an additional long-term symptom. The hyperstimulation of tracheal goblet cells secreting mucus is 1 pathophysiological hypothesis.

  • Abdalla Khalil, Badr Badr, Harry Wright, Mohammed Talo, Mohammad Atteiya

    Introduction: Co-infection with COVID-19 and other viral or bacterial infections has been described in many studies. Most cases of dengue fever in Saudi Arabia have been reported in Jeddah city and mainly during the summer season.

    Method and results: We describe four patients who presented to the emergency department with febrile illness accompanied by symptoms and blood tests suggestive of dengue fever. They also had radiological findings suggestive of COVID-19 chest infection and positive PCR tests. Three of the patients required hospital admission, and all had a good outcome.

    Conclusion: In areas with a high rate of dengue fever, serological screening for dengue fever should be considered as part of COVID-19 investigation, especially if symptoms or a full blood count are suggestive.

  • Ahmet Cumhur Dülger, Mustafa Yakarişik; Yusuf Emre Uzun, Ahmet Melih Şahin

    Introduction: Crimean-Congo haemorrhagic fever (CCHF) is a lethal zoonotic disease caused by an RNA virus that is a member of the Nairovirus genus in the Bunyaviridae family from the arbovirus group. CCHF is transmitted by Hyalomma ticks through direct contact with the blood and other bodily fluids of patients or infected animals.

    Case description: A 65-year-old man was admitted to the emergency unit with dry cough, myalgia and fever. He was treated with favipiravir. He had disseminated intravascular coagulopathy with thrombocytopenia in the setting of COVID-19 infection. He tested positive for both COVID-19 and CCHF. By the end of the fifth day of treatment, his laboratory parameters and clinical symptoms had normalized.

    Conclusion: Favipiravir is currently on the market for treating COVID-19 infection worldwide. It has also been used to treat CCHF in laboratory animals. To the best of our knowledge this is the first report of CCHF successfully treated with favipiravir, which could be a key drug for treating human CCHF.

  • Rehab AL-Ansari, Mohanad Bakkar , Leena Abdalla , Khaled Sewify

    Background: Thrombotic thrombocytopenic purpura (TTP) is an uncommon haematological disease which can occur at any age and may present with COVID-19. This case describes a COVID-19 complication associated with a presentation resembling TTP.

    Case description: A 51-year-old man who had received a kidney transplant and was on immunosuppressant medication, was admitted to a critical care unit with severe COVID-19 pneumonia/acute respiratory distress syndrome (ARDS) which required intubation, mechanical ventilation and inotropic support. The course was complicated by the classic pentad of thrombocytopenia, intravascular haemolysis, acute kidney injury, neurological symptoms and fever, which prompted the diagnosis of probable TTP. After five sessions of therapeutic plasma exchange, the patient’s general status improved, he was weaned off mechanical ventilation and his renal panel and haemolytic markers normalized.

    Conclusion: TTP is a life-threatening condition which requires urgent management with therapeutic plasma exchange. This case highlights some possible complications of COVID-19 generally and in immunocompromised patients specifically. The potential role of plasma exchange in COVID-19 patients without a positive diagnosis of TTP (the so-called ‘TTP resembling presentation’) is an area of further research.

  • Maria Cristina Pasqualetto, Maria Domenica Sorbo, Maria Vitiello, Chiara Ferrara, Moreno Scevola, Fabio Pantalone, Fabio Gelain, Claudio Aloi, Manuele Nizzetto, Fausto Rigo

    A patient affected by COVID-19 pneumonia may develop pulmonary hypertension (PH) and secondary right ventricular (RV) involvement, due to lung parenchymal and interstitial damage and altered pulmonary haemodynamics, even in non-advanced phases of the disease. This is a consequence of hypoxic vasoconstriction of the pulmonary circulation, the use of positive end-expiratory pressure (PEEP) in mechanical ventilation, pulmonary endothelial injury, and local inflammatory thrombotic and/or thromboembolic processes.
    We report the case of a young man admitted with a diagnosis of COVID-19 pneumoniae with PH unrelated to viral infection and in whom partial anomalous pulmonary venous drainage (PAPVD) was eventually diagnosed.

  • Morika Suzuki, Genya Watanabe, Takashi Watari

    Meningitis-retention syndrome (MRS) is a rare disorder where aseptic meningitis is accompanied by urinary retention, which can be easily misdiagnosed as urinary tract infection. We present the case of a 55-year-old man with fever and dysuria. At the time of hospitalization, the patient had no symptoms of meningitis, but signs of meningeal irritation appeared later during the course of the disease. Investigation revealed that this was a case of MRS due to Epstein–Barr virus. We have to consider MRS when examining patients with fever and urinary retention, as dysuria may precede meningitis symptoms.

  • Tiago Rabadão, Leonor Naia, Filipa Ferreira, Mariana Teixeira, Marcelo Aveiro, Margarida Eulálio, Susana Calretas

    The elimination of the aetiological factors causing liver injury is an important cornerstone in preventing progression and increasing survival in patients with cirrhosis. The authors present the case of a 63-year-old woman with a history of long-term alcohol abuse and consequent liver cirrhosis. Over the years, the patient presented progressive deterioration with severe malnutrition and had multiple hospital admissions due to decompensated cirrhosis, including refractory ascites, variceal bleeding and an extensive portal vein thrombosis (PVT). Anticoagulant therapy was not initiated due to a high risk of variceal bleeding. She eventually became abstinent, but PVT precluded a liver transplant. Over the following 10 years, her performance status gradually improved, with no new decompensation episodes and liver function normalization, although refractory ascites persisted. Abdominal CT showed spontaneous recanalization of the portal vein and a transjugular intrahepatic portosystemic shunt (TIPS) procedure was performed with gradual improvement of ascites. In this atypical case, an unexpected favourable evolution of advanced stage cirrhosis was observed with long-term improvement in clinical status and liver function, resulting in an estimated 10-year cumulative mortality rate of 99.98% and highlighting the importance of abstinence. Unexpectedly, spontaneous complete repermeabilization of the PVT was also observed, despite its extent and the absence of anticoagulation therapy.

  • Marcelo Aveiro, Gisela Ferreira, Carla Matias, Ana Oliveira, Tatiana Rodrigues

    Autoimmune haemolytic anaemia (AIHA) is an uncommon condition characterized by increased destruction of erythrocytes associated with reticulocytosis in the great majority of cases. We present the case of a 68-year-old woman with jaundice and malaise. Investigation revealed AIHA with reticulocytopenia. The patient failed to respond to prednisolone or to rituximab. Azathioprine and epoetin beta were subsequently started, the prednisolone dose was increased, and the patient began to respond after 1 month. In AIHA, reticulocytopenia is a very rare presentation and a sign of great severity and poor outcome. The scarcity of therapeutic options in refractory cases poses a major challenge for physicians.

     

  • Takahiro Ito, Hiroshi Sawachika, Yukinori Harada, Taro Shimizu

    A 60-year-old man was admitted with a 1-month history of fever and weight loss. Multiple lymphadenopathies and haemophagocytic lymphohistiocytosis were noted from the beginning, suggesting lymphoma. However, lymph node biopsy was deferred because lymph node biopsy was regarded as being invasive and requires general anaesthesia, and because other possible differential diagnoses including gastrointestinal malignancies and TAFRO syndrome were being considered. Instead, investigations including gastrointestinal endoscopy and bone marrow biopsy were prioritized. The patient was eventually diagnosed with Hodgkin’s lymphoma based on lymph node biopsy but died during chemotherapy. Physicians should prioritize the tests that are most directly related to the diagnostic outcome, even if they are invasive.

  • Ana Sá, Teresa Pimentel, Narciso Oliveira

    An 87-year-old man was admitted with a 2-week history of asthenia, anorexia and jaundice. Blood tests showed increased serum liver enzymes. The aetiological study was inconclusive. The patient had a favourable clinical evolution during hospitalization with supportive care. His wife revealed that the patient had repeatedly consumed infusions of Peumus boldus (commonly known as boldo) leaves during the previous month. After common causes of hepatobiliary pathology were excluded, boldo-induced hepatotoxicity was considered probable. Cessation of its consumption led to complete clinical and laboratory recovery within a week.

  • Carolina Amado, Pedro Gonçalo Ferreira

    Pleuroparenchymal fibroelastosis (PPFE) is a relatively rare interstitial lung disease (ILD) consisting of elastofibrosis involving the subpleural parenchyma and visceral pleura with an upper lobe predominance. It can be idiopathic or associated with some forms of autoimmune disease. The authors describe the case of a 78-year-old woman with a previous diagnosis of Crohn’s disease (CD). She presented with a protracted respiratory infection (with no significant history of previous infections), and underwent high-resolution chest computerized tomography that eventually showed alterations compatible with PPFE. After exclusion of other possible underlying causes, a possible link to CD was considered. Follow-up investigation at 12 months showed clinical and radiological stability and also stable lung function under treatment with hydroxychloroquine and prednisolone. This is the first report of PPFE in the context of CD. Future studies will be important to further investigate this pathological association and its prognostic implications.

  • Dimitra Koumaki, Vasiliki Koumaki, Alexander Katoulis, Sotirios Boumpoucheropoulos, George Evangelou, Maria Stefanidou, Konstantinos Krasagakis

    Trimebutine is a spasmolytic agent with antimuscarinic effects that is used for the treatment of irritable bowel syndrome (IBS) and lower gastrointestinal tract motility disorders. Lichenoid drug eruptions (LDE) to trimebutine maleate have not been previously reported. Here we present the case of a 50-year-old male patient who developed an extensive lichenoid eruption on his upper and lower extremities and trunk 4 weeks after starting treatment with trimebutine maleate 300 mg once daily for IBS. Two months after discontinuation of the drug and administration of topical treatment with emollients and corticosteroids, the LDE cleared completely with no recurrence. The diagnosis of LDE due to trimebutine was made, based upon the clinical features resembling lichen planus, the histological findings of interface dermatitis, the evidence of a temporal relationship between drug intake and the development of skin lesions, and resolution upon discontinuation of the drug. To the best of the authors’ knowledge, LDE following trimebutine maleate intake has not been previously reported. Management of trimebutine-induced LDE includes withdrawal of the causative agent and treatment with potent topical corticosteroids.

  • Jorge Miguel Bastos Mendes, João Filipe Ferreira Gomes, Lurdes Rovisco Branquinho, Catarina Oliveira Carvalho, Patrícia Filipa Afonso Pais Pacheco Mendes, João Luís Carvalho Madaleno

    Introduction: Chest pain is a very frequent reason for seeking medical care. When there is no obvious cause, patients are sometimes subjected to tests and treatments that may be unnecessary and potentially harmful. Mondor's disease is a rare but usually benign and self-limited entity characterized by thrombophlebitis in a specific region.

    Case report: We report the clinical case of a 51-year-old man admitted to the emergency department with a 24-hour history of left chest pain with no other symptoms. Physical examination revealed a palpable subcutaneous cord-like structure that ultrasound confirmed to be thrombophlebitis of a superficial vein in the mammary region. Secondary causes were ruled out, and the condition resolved with ibuprofen and the application of local ice.

    Discussion: Mondor’s disease can be associated with neoplasms, trauma or hyperviscosity states, but it is mostly idiopathic. Usually, it resolves completely in 4–8 weeks without specific treatment. Because this infrequent diagnosis mainly relies on clinical findings, it is important that clinicians can recognize the syndrome.

  • Mohamed Reda Belkhribchia, Sara Moukhlis, Tarik Bentaoune, Najat Chourkani, Mohamed Zaidani, Mehdi Karkouri

    Monoclonal gammopathies due to plasma cell dyscrasias can cause various rare neuromuscular disorders. The peripheral nervous system is most commonly affected, while muscle diseases associated with monoclonal gammopathies are rare. Skeletal myopathy, as a manifestation in the context of multiple myeloma, is extremely uncommon and is usually the result of immunoglobulin light chain (AL) amyloidosis deposits in the muscles. Here we present an atypical case of a patient with generalized myopathy as the presenting manifestation of light chain multiple myeloma. Interestingly, muscle involvement in our case was not the consequence of AL amyloidosis deposits but rather due to non-amyloid light chain deposition disease associated with light chain multiple myeloma.

  • Oumniya Abouhanine, Aicha Merzem, Vianney Ndayishimiye, Hasnaa Belgadir, Omar Amriss, Nadia Moussali, Naima El Benna

    Introduction: Epidermoid cysts of the temporal bone are rare, benign and slow-growing lesions.

    Patient and Methods: We report the case of a 69-year-old female patient followed up for a symptomatic intradiploic epidermoid cyst of the temporal scale and left mastoid region, which had been operated on but recurred.

    Results: MRI demonstrated a well-limited lesion seen as a hyposignal on T1-weighted images, hypersignal on T2-weighted images, on FLAIR and on diffusion-weighted images not enhanced by gadolinium. The tumour was compressive, and bone lysis was seen on CT.

    Conclusion: Epidermoid cysts of the temporal bone are rare, benign lesions whose diagnosis is based on fluid signals seen on MRI but absent on FLAIR sequences.

  • Marcelo Aveiro, Tatiana Rodrigues, Tiago Rabadão, Filipa Ferreira, Mariana Teixeira, Ana Oliveira, Inês Vasconcelos

    Gastric antral vascular ectasia (GAVE) is a rare cause of upper gastrointestinal bleeding associated with cirrhosis. The first-line treatment is endoscopic therapy with argon plasma coagulation (APC). There is a high recurrence rate, but some evidence suggests that thalidomide could play an important role in controlling refractory anaemia due to GAVE. The authors present the case of a cirrhotic patient with a recent diagnosis of GAVE, who underwent multiple endoscopic treatments and blood transfusions because of haematemesis. The patient started thalidomide and 6 months later, there was no recurrence of haematemesis and haemoglobin levels were stable, with no reported adverse effects.

  • Abir Derbel, Mariam Ghribi, Sameh Marzouk, Zouhir Bahloul

    The coexistence of two immune-mediated diseases in the same patient is unusual. Takayasu’s arteritis (TA), which is a chronic granulomatous vasculitis, was discovered in a 47-year-old woman followed for tubulointerstitial nephritis and uveitis syndrome (TINU syndrome). We present the first case of this association.

  • Ali Hamza Khair, Aimen Asim Dar, Abu Baker Sheikh, Aamir Iftikhar Malik

    Paraneoplastic pemphigus arising in association with non-haematological cancers is extremely rare, and there are no reported cases of a patient developing this in the setting of nasopharyngeal carcinoma and only 2 reported cases of patients developing this in response to radiotherapy. Here, we present the case of a patient who developed radiotherapy-associated paraneoplastic pemphigus in the setting of nasopharyngeal carcinoma and who then developed multiple complications.

  • Oumniya Abouhanine, Aicha Merzem, Vianney Ndayishimiye, Omar Amriss, Hasnaa Belgadir, Nadia Moussali, Naima El Benna

    Introduction: Chondrosarcoma is a tumour with a cartilaginous matrix frequently encountered in long bones and the pelvis with rare sinonasal location.
    Patient and methods: We report the case of a 25-year-old patient who was referred to us for an extension work-up for sinonasal chondrosarcoma confirmed by anatomopathological examination.
    Results: Facial magnetic resonance imaging (MRI) confirmed by a CT scan showed an osteolytic tumour process of the hard palate and walls of the left maxillary sinus that was locally advanced.
    Conclusion: The sinonasal location of a chondrosarcoma is rare. Characterized by cross-sectional imaging, confirmation was provided by histological assessment.

  • Anirudha S Rathnam , Anza B Memon

    Foix-Alajouanine syndrome is an arteriovenous malformation causing subacute congestive myelopathy that can lead to progressive paraplegia. It typically affects the lower thoracic and lumbosacral levels. Arteriovenous fistula (AVF) leads to increased venous pressure, decreasing the arteriovenous pressure gradient and leading to a decrease in spinal cord perfusion, oedema and necrosis. Early recognition and surgical intervention can result in a good prognosis.

  • Mihiro Kaga, Emi Yamashita, Takeshi Ueda

    Objectives: The aquarium sign is the name given to a large quantity of bubble-like echoes that suggests the presence of hepatic portal venous gas (HPVG). Few studies in the literature have addressed the relationship between the aquarium sign and HPVG. In some cases, HPVG can only be detected using ultrasonography. HPVG can be observed in a variety of conditions, including those that require emergency surgery, such as acute mesenteric ischaemia (AMI). Therefore, it is important to identify the presence of HPVG as soon as possible. 
    Materials and methods: We report a case of the aquarium sign, where bubble-like echoes flowed from the right atrium towards the right ventricle, which was identified using bedside cardiac ultrasonography as part of a point-of-care ultrasound test.
    Results: This aquarium sign finding led to the diagnosis of AMI, which was confirmed using contrast-enhanced computed tomography (CT). 
    Conclusion: The aquarium sign is a useful finding suggestive of HPVG and mesenteric ischaemia, which can be rapidly and easily observed using bedside cardiac ultrasonography. However, there are very few reports on the aquarium sign. The inability of other more cumbersome diagnostic imaging modalities, such as CT and magnetic resonance imaging, to detect HPVG emphasizes the utility and convenience of detecting the aquarium sign using bedside ultrasonography. This technique can lead to early detection of life-threatening diseases as well as improve the prognosis for patients. The diagnostic implications of the aquarium sign for HPVG are still unclear and require further research.

  • Aamir Shahzad, Adeel Ahmad Khan, Muhammad Awais Arif, Zohaib Yousaf

    Introduction: Exertional heat illness (EHI) is common in hot weather among young athletes, outdoor manual workers and military personnel. EHI can involve multiple organs of the body, including the muscles, kidneys and brain; however, myocardium involvement is infrequent.
    Materials and methods: We present the case of a 26-year-old male construction worker who worked outdoors in a hot arid environment. He presented with acute kidney injury and rhabdomyolysis and was diagnosed with EHI. During his hospital stay, he developed complete heart block, and cardiac MRI showed features of myocarditis. Work-up to identify other aetiologies of myocarditis was normal. This case highlights the effects of EHI on the myocardium.
    Conclusion: It is important to keep in mind the various effects of EHI on the myocardium. Myocarditis due to EHI is rare, and conduction defects resulting from it might persist, necessitating specialist intervention.

  • Christopher Balfe, Cormac O'Connor, Gerard Giblin, Kevin Walsh, Ivan Casserly, David Moore, Vincent Maher

    This case report describes a young female Caucasian patient with newly presenting severe mitral stenosis at the peak of the coronavirus pandemic in the Republic of Ireland.
    The initial presumptive diagnosis was of severe coronavirus illness. This case report highlights the importance of keeping an open mind to alternative diagnoses and examines some of the challenges in the diagnosis and management of a rare condition in the pandemic environment.
    This patient gained 10 kg of weight within 6 weeks of percutaneous balloon mitral valvuloplasty, highlighting the contribution of cardiac cachexia to her low body weight and demonstrating the exceptional benefit that this treatment can offer to patients.

  • Carolina Amado, Gisela Ferreira, Fernando Silva, Mariana Silva Leal, Margarida Cruz

    Bendamustine is a chemotherapeutic drug associated with frequent haematological and gastrointestinal adverse effects and, more rarely, neurological toxicity.
    We present the case of a 79-year-old man with follicular lymphoma, grade 2, Ann-Arbor stage IV-A, FLIPI 4, high risk, with bulky disease and vital organ compression, treated with R-CHOP and then rituximab-bendamustine, who developed encephalopathy approximately 2 months after the last cycle. After ruling out other possible aetiologies, we assumed the patient’s encephalopathy was due to a delayed bendamustine side effect, possibly aggravated by the concomitant administration of rituximab.
    The authors hope to alert clinicians to this rare adverse effect, its difficult identification and the need to rule out other aetiologies.

  • Antón FR Gameiro, António Robalo Nunes, Paula Guerra, Estela Mateus, Fátima Fernandes

    Portal vein thrombosis (PVT) is an uncommon finding in patients without cirrhosis. The underlying aetiology is challenging and the condition has a wide differential diagnosis. We present a case of PVT in an anaemic patient with chronic iron and folic acid deficiency masking underlying polycythemia vera (PV). Only a careful review of the patient’s clinical history allowed the identification of a short period of laboratory erythrocytosis, 6 months before the clinical onset of PVT, while the patient was on iron and folic acid supplementation. The finding raised clinical suspicion of PV previously masked by iron deficiency anaemia. Subsequent investigation confirmed the presence of the JAK2 V617F mutation and, ultimately, showed that the patient met all diagnostic criteria for PV. Myeloproliferative disorders (MPD) are associated with systemic prothrombotic states. PV is distinguished clinically from other MPD by the presence of increased red blood cell mass. Moreover, patients with abnormal haematocrit values in the pre-JAK2 V617F era may have had occult or latent PV. Diagnosis confirmation requires a combination of major and minor criteria to capture occasional cases of occult PV. This case emphasizes the importance of always considering MPD in the aetiological investigation of PVT, even in patients who apparently do not fulfil the diagnostic criteria.

  • Marta Carreira, Joana Pimenta

    Gastrointestinal duplications are rare congenital anomalies usually found incidentally in asymptomatic adult patients. We report a case of methicillin-resistant Staphylococcus aureus and Candida albicans secondary bloodstream co-infection in a 57-year-old male patient with a communicating tubular oesophageal duplication. The patient completed 21 days of medical treatment with vancomycin and anidulafungin and remained well without any complications, over 2 years of follow-up.

  • Alba Bergas, Francesc Escrihuela-Vidal, Davinia Fernández Calvo, Olga Capdevila Pons, Xavier Corbella

    Spontaneous haemothorax (SH) is a rare subcategory of haemothorax that involves the accumulation of blood within the pleural space in the absence of trauma. SH especially occurs in middle-aged or elderly patients, but data are usually limited to case reports and case series. Coagulopathy, aneurysm or aortic dissection, Rendu-Osler-Weber syndrome and malignancy have to be considered among the causes of SH.
    Aim: We describe a case of primary angiosarcoma of the spleen presenting as relapsing haemothorax.
    Results: An 81-year-old woman was referred to our hospital because of a 2-month history of relapsing haemothorax after the performance of urgent splenectomy due to active bleeding from large spleen cysts. No evidence of neoplasm was seen after pathological examination of the spleen. On admission, left haemothorax and 2 new cystic masses in the thoracic wall were documented, both in close relation to the scars of previous surgery and chest tubes. After excision of 1 mass, histological examination revealed angiosarcoma, and a final diagnosis of primary angiosarcoma of the spleen with postsurgical metastatic dissemination to the thorax and pleura was made.
    Conclusion: Primary angiosarcoma should be included in the differential diagnosis of haemorrhagic spleen cysts. Clinical diagnosis and management usually requires splenectomy, but it should be carefully planned in order to avoid local metastatic dissemination or haematogenous spread of the tumour.

  • Murtaza Hussain, Smit S Deliwala, Anoosha Ponnapalli, Viraj Modi, Ashok Kanugula, Mamoon M Elbedawi, Ghassan Bachuwa

    Acute pancreatitis (AP) remains one of the most common causes of emergency department visits in the USA. The literature supports an association between angiotensin-converting enzyme inhibitors (ACEi), mainly at steady-state doses, and AP. We present a case of recurrent AP and pseudocyst formation following multiple ACEi dose adjustments after a steady-state period lasting for over a decade. Previous reports have rarely described ACEi-induced pancreatitis and pseudocyst development. ACEi can cause significant ductal obstruction and fluid retention due to its angioedema effects. Consequently, it may trigger AP complicated by pseudocyst formation. Therefore, ACEi administration must be considered in the appropriate clinical context.

  • Van Trung Hoang, Hoang Anh Thi Van, Hoang Quan Nguyen, Ngoc Trinh Thi Pham, Minh Tri Thi Vo, Vichit Chansomphou, Cong Thao Trinh

    Intracranial neurenteric cysts are rare congenital lesions that can be mistaken for other lesions. They may contain mucous or serous glands, smooth muscle, lymphoid tissue and components of connective tissue. We report a case of neurenteric cyst which was detected accidentally by diagnostic imaging in the context of a thalamus infarct in a 45-year-old woman. We also discuss the results of a brief literature review and the pathological findings, imaging spectrum, evaluation and management of neurenteric cysts and thalamic infarctions.

  • Giorgia Protti, Fabrizio Elia, Francesca Bosco, Franco Aprà

    Among thrombophilic risk factors for deep venous thrombosis (DVT), agenesis of the inferior vena cava (AIVC) is very rare, but it must be considered in specific settings. Here, we present the case of an 18-year-old woman who was admitted to the Emergency Department with swelling and pain of her left leg. Clinical examination and ultrasonography detected extensive proximal DVT of the left leg. After attempted mechanical thrombectomy failed, an abdominal CT scan was obtained, which demonstrated bilateral thrombosis of the iliac-femoral axis in the context of congenital AIVC.