Upper arm deep vein thrombosis in a patient with active lupus
Upper extremity deep vein thrombosis (UEDVT) is relatively rare, and much less as an initial presentation of systemic lupus erythematosus (SLE). Primary UEDVT should be considered in individuals with unilateral arm swelling where the brachial, axillary, and subclavian veins are frequently involved....
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| Format: | Article |
| Language: | English |
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SMC MEDIA SRL
2024-12-01
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| Series: | European Journal of Case Reports in Internal Medicine |
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| Online Access: | https://www.ejcrim.com/index.php/EJCRIM/article/view/5056 |
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| author | Mahmoud Farouk Kamel Hassanein Alaa Ebrahim Stephanie Alcine Joseph Teresa Jack Ramprasath Anbazhagan Miguel Fernández Olivares Olena Kovalska |
| author_facet | Mahmoud Farouk Kamel Hassanein Alaa Ebrahim Stephanie Alcine Joseph Teresa Jack Ramprasath Anbazhagan Miguel Fernández Olivares Olena Kovalska |
| author_sort | Mahmoud Farouk Kamel Hassanein |
| collection | DOAJ |
| description | Upper extremity deep vein thrombosis (UEDVT) is relatively rare, and much less as an initial presentation of systemic lupus erythematosus (SLE). Primary UEDVT should be considered in individuals with unilateral arm swelling where the brachial, axillary, and subclavian veins are frequently involved. SLE is a chronic autoimmune disease that predominantly affects women of childbearing age and of African descent. Patients present with clinical features ranging from arthritis and arthralgias (over 90% of patients with SLE) to life-threatening hematologic, or central nervous system involvement. Individuals have an increased risk of arterial and/or venous thrombosis where the most important risk factor is the presence of antiphospholipid antibodies. Even within this condition, thrombotic events are typically seen in the legs, and UEDVT remains an unusual presentation. Here, we present a case of a 36-year-old female of African descent with a recent medical history of small joint arthralgia and vaginal bleeding due to uterine fibroids, for which she was prescribed a short course of prednisolone and norethisterone, respectively. She presented with a 2-week history of unilateral swelling in the left arm. Doppler ultrasound and later computed tomography scan with contrast indicated left UEDVT. Further investigations throughout her admission led to the diagnosis of SLE, while antiphospholipid syndrome - a common contributor to thrombosis in SLE - was notably ruled out. The patient was initiated on anticoagulants. The patient went on to later rapidly develop lupus nephritis and started on high-dose prednisolone. Given the high risk of bleeding, the decision to postpone the kidney biopsy was taken. There is limited data available about UEDVT when compared to lower extremity DVT and even fewer studies on SLE patients with thrombosis in the absence of antiphospholipid syndrome. Keeping this in mind, clinicians need to recognize idiopathic UEDVT as a potential early sign of SLE and maintain a high level of suspicion. |
| format | Article |
| id | doaj-art-1d167eaff2d94657a3eb511e9f38669d |
| institution | Kabale University |
| issn | 2284-2594 |
| language | English |
| publishDate | 2024-12-01 |
| publisher | SMC MEDIA SRL |
| record_format | Article |
| series | European Journal of Case Reports in Internal Medicine |
| spelling | doaj-art-1d167eaff2d94657a3eb511e9f38669d2025-01-07T13:40:28ZengSMC MEDIA SRLEuropean Journal of Case Reports in Internal Medicine2284-25942024-12-0110.12890/2024_0050564591Upper arm deep vein thrombosis in a patient with active lupusMahmoud Farouk Kamel Hassanein0Alaa Ebrahim1Stephanie Alcine Joseph2Teresa Jack3Ramprasath Anbazhagan4Miguel Fernández Olivares5Olena Kovalska6Department of Internal Medicine, Seychelles Hospital, Healthcare Agency, Victoria, SeychellesDepartment of Internal Medicine, Seychelles Hospital, Healthcare Agency, Victoria, SeychellesDepartment of Internal Medicine, Seychelles Hospital, Healthcare Agency, Victoria, SeychellesDepartment of Internal Medicine, Seychelles Hospital, Healthcare Agency, Victoria, SeychellesDepartment of Internal Medicine, Seychelles Hospital, Healthcare Agency, Victoria, SeychellesNephrology Division, Seychelles Hospital, Healthcare Agency, Victoria, SeychellesRadiology Department, Seychelles Hospital, Healthcare Agency, Victoria, SeychellesUpper extremity deep vein thrombosis (UEDVT) is relatively rare, and much less as an initial presentation of systemic lupus erythematosus (SLE). Primary UEDVT should be considered in individuals with unilateral arm swelling where the brachial, axillary, and subclavian veins are frequently involved. SLE is a chronic autoimmune disease that predominantly affects women of childbearing age and of African descent. Patients present with clinical features ranging from arthritis and arthralgias (over 90% of patients with SLE) to life-threatening hematologic, or central nervous system involvement. Individuals have an increased risk of arterial and/or venous thrombosis where the most important risk factor is the presence of antiphospholipid antibodies. Even within this condition, thrombotic events are typically seen in the legs, and UEDVT remains an unusual presentation. Here, we present a case of a 36-year-old female of African descent with a recent medical history of small joint arthralgia and vaginal bleeding due to uterine fibroids, for which she was prescribed a short course of prednisolone and norethisterone, respectively. She presented with a 2-week history of unilateral swelling in the left arm. Doppler ultrasound and later computed tomography scan with contrast indicated left UEDVT. Further investigations throughout her admission led to the diagnosis of SLE, while antiphospholipid syndrome - a common contributor to thrombosis in SLE - was notably ruled out. The patient was initiated on anticoagulants. The patient went on to later rapidly develop lupus nephritis and started on high-dose prednisolone. Given the high risk of bleeding, the decision to postpone the kidney biopsy was taken. There is limited data available about UEDVT when compared to lower extremity DVT and even fewer studies on SLE patients with thrombosis in the absence of antiphospholipid syndrome. Keeping this in mind, clinicians need to recognize idiopathic UEDVT as a potential early sign of SLE and maintain a high level of suspicion.https://www.ejcrim.com/index.php/EJCRIM/article/view/5056upper extremity deep venous thrombosissystemic lupus erythematosuslupus nephritisantiphospholipid syndromepaget-schroetter syndrome |
| spellingShingle | Mahmoud Farouk Kamel Hassanein Alaa Ebrahim Stephanie Alcine Joseph Teresa Jack Ramprasath Anbazhagan Miguel Fernández Olivares Olena Kovalska Upper arm deep vein thrombosis in a patient with active lupus European Journal of Case Reports in Internal Medicine upper extremity deep venous thrombosis systemic lupus erythematosus lupus nephritis antiphospholipid syndrome paget-schroetter syndrome |
| title | Upper arm deep vein thrombosis in a patient with active lupus |
| title_full | Upper arm deep vein thrombosis in a patient with active lupus |
| title_fullStr | Upper arm deep vein thrombosis in a patient with active lupus |
| title_full_unstemmed | Upper arm deep vein thrombosis in a patient with active lupus |
| title_short | Upper arm deep vein thrombosis in a patient with active lupus |
| title_sort | upper arm deep vein thrombosis in a patient with active lupus |
| topic | upper extremity deep venous thrombosis systemic lupus erythematosus lupus nephritis antiphospholipid syndrome paget-schroetter syndrome |
| url | https://www.ejcrim.com/index.php/EJCRIM/article/view/5056 |
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