Thesis

2. A case of Recurrent and extensive thrombosis in an adolescent male
-Dr Tharesh Babu sr, Dr Athulya, Dr Sreevidya
ABSTRACT
 We present a case of 13 year old male with k/c/o bilateral unprovoked DVT was on regular
anticoagulant therapy (Tab Rivoroxaban 10mg BD) stopped medications recently and was on
ayurvedic medications, came with c/o abdominal pain since 1 week, fever since 1 week, dyspnea since
1week, loose stools since 3 days. Patient also had past history of recurrent fever episodes and gum
bleeding, on examination tachycardia+,Right sided subconjunctival haemorrhage+, bilateral upper
and lower limbs purpura+, i/v/o high clinical suspicion of pulmonary embolism emergency CTPA and
CECT Abdomen was taken which showed acute pulmonary thromboembolism and splenic venous
infarcts. routine investigations showed mild leukocytosis and severe thrombocytopenia at
presentation , patient remained febrile and thrombocytopenia worsened, On day 2-peripheral smear
Reported as Acute myeloid leukemia with 68% blast cells, MPO+ ,Acute promyelocytic leukemia to be
ruled out.PT/INR, APTT , d-dimer were elevated s/o DIC
 Diagnosis: Acute pulmonary thromboembolism, B/L DVT, DIC, Secondary to Acute myeloid leukemia,
probable acute promyelocytic leukemia
 Intervention: i/v/o severe thrombocytopenia and bleeding manifestations patient could not be
heparinized and was supportively managed with platelets and FFP transfusion and referred to RCC
Trivendrum for further management
 Outcome: Early treatment initiation with ATRA therapy and supportive measures has good prognosis
 Lessons: Unprovoked venous thromboembolism should always be evaluated for underlying age
appropriate malignancies and inherited thrombophilias, which was missed in this patient