open access

Vol 64, No 4 (2006)
Other
Published online: 2006-04-27
Submitted: 2012-12-28
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Case report
Massive pulmonary embolism in a patient with ulcerative colitis and hyperhomocysteinemia – a case report

Krzysztof Wrabec
Kardiol Pol 2006;64(4):405-409.

open access

Vol 64, No 4 (2006)
Other
Published online: 2006-04-27
Submitted: 2012-12-28

Abstract

We describe a case of a 37-year-old man with active ulcerative colitis complicated by proximal deep vein thrombosis of the left lower limb and subsequent massive pulmonary embolism requiring mechanical ventilation and catecholamine infusion. In spiral CT a large thrombus obturating left pulmonary artery as well as bilateral embolic material in lobar and segmental branches were visible. Haemodynamic status improved after infusion of rtPA. Haemoglobin decrease (7.0–5.6 mmol/L) was corrected with erythrocyte mass transfusion. During subsequent therapy with intravenous full dose of unfractionated heparin and further long-term treatment with subcutaneous enoxaparin (1.5 mg/kg and after 3 months 1.0 mg/kg daily) haemoglobin value was relatively stable. Underlying disease was treated with 5-ASA (mesalazine) and steroids. Due to hyperhomocysteinaemia (16.0 µmol/L) coexisting with a low plasma folic acid (2.1 ng/ml) and cyanocobalamin (137 pg/ml) levels, supplementation with these vitamins was prescribed. The screening tests for familial thrombophilia (including 677C→T MTHFR mutation) were negative. The authors discuss the pathogenesis of increased thromboembolic risk in inflammatory bowel disease and therapeutic dilemmas connected with treatment of such complications.

Abstract

We describe a case of a 37-year-old man with active ulcerative colitis complicated by proximal deep vein thrombosis of the left lower limb and subsequent massive pulmonary embolism requiring mechanical ventilation and catecholamine infusion. In spiral CT a large thrombus obturating left pulmonary artery as well as bilateral embolic material in lobar and segmental branches were visible. Haemodynamic status improved after infusion of rtPA. Haemoglobin decrease (7.0–5.6 mmol/L) was corrected with erythrocyte mass transfusion. During subsequent therapy with intravenous full dose of unfractionated heparin and further long-term treatment with subcutaneous enoxaparin (1.5 mg/kg and after 3 months 1.0 mg/kg daily) haemoglobin value was relatively stable. Underlying disease was treated with 5-ASA (mesalazine) and steroids. Due to hyperhomocysteinaemia (16.0 µmol/L) coexisting with a low plasma folic acid (2.1 ng/ml) and cyanocobalamin (137 pg/ml) levels, supplementation with these vitamins was prescribed. The screening tests for familial thrombophilia (including 677C→T MTHFR mutation) were negative. The authors discuss the pathogenesis of increased thromboembolic risk in inflammatory bowel disease and therapeutic dilemmas connected with treatment of such complications.
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Keywords

massive pulmonary embolism; ulcerative colitis; thromboembolic risk in inflammatory bowel disease; hyperhomocysteinaemia; heparin therapy

About this article
Title

Case report
Massive pulmonary embolism in a patient with ulcerative colitis and hyperhomocysteinemia – a case report

Journal

Kardiologia Polska (Polish Heart Journal)

Issue

Vol 64, No 4 (2006)

Pages

405-409

Published online

2006-04-27

Bibliographic record

Kardiol Pol 2006;64(4):405-409.

Keywords

massive pulmonary embolism
ulcerative colitis
thromboembolic risk in inflammatory bowel disease
hyperhomocysteinaemia
heparin therapy

Authors

Krzysztof Wrabec

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