Thrombotic storm in a teenager with previously undiagnosed ulcerative colitis.

Abstract:

:Venous thrombosis can complicate inflammatory bowel diseases, both in adult and pediatric patients, and a few adult cases of thrombotic storm, ie, thrombosis at multiple sites occurring over a period of a few days to a few weeks, have been described. However, venous thrombosis as the first manifestation of an inflammatory bowel disease is extremely rare. We report the case of a 14-year-old girl presenting with ascites and marked hypertransaminasemia resulting from hepatic vein occlusion (Budd-Chiari syndrome). Despite anticoagulant therapy, in the following days she developed criteria suggestive of thrombotic storm to include cerebral vein, right atrial thrombosis, and bilateral pulmonary embolism. Thrombolytic treatment with recombinant-tissue plasminogen activator was started, with resolution of all venous thromboses and without bleeding complications. Additional examinations revealed a severely active ulcerative pancolitis, which did not respond to medical treatment and required surgery. No thrombophilia abnormality nor other risk factors for thrombosis were detected. We conclude that an underlying inflammatory state, such as ulcerative colitis, should be suspected in pediatric patients with venous thrombosis storm.

journal_name

Pediatrics

journal_title

Pediatrics

authors

Maggi U,Rossi G,Avesani EC,Artoni A,Caprioli F,Napolitano L,Martinelli I

doi

10.1542/peds.2012-2365

subject

Has Abstract

pub_date

2013-04-01 00:00:00

pages

e1288-91

issue

4

eissn

0031-4005

issn

1098-4275

pii

peds.2012-2365

journal_volume

131

pub_type

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