A rare case of unprovoked venous thromboembolism manifestation in a young patient with antithrombin Type IIB deficiency combined with inferior vena cava anomaly from Lithuania.

Abstract

Hereditary antithrombin (AT) deficiency is an autosomal-dominant disorder predisposing to venous and arterial thrombosis. Homozygosity resulting in severe AT deficiency is not compatible with life, apart from homozygous mutations affecting the heparin-binding site representing the most severe thrombophilia.

PATIENTS AND METHODS:

A 12-year-old previously healthy boy of Romani origin presented with a swollen, painful left leg and fever. Imaging revealed signs of inferior vena cava (IVC) thrombosis, the presence of interrupted intrahepatic IVC with azygos continuation and bilateral iliofemoral thrombosis with enlargement of the azygous and hemiazygos venous system. In addition, right pleural effusion and signs of bilateral renal pericortical cysts, possibly caused by retroperitoneal lymphangiectasia, were disclosed. Thrombophilia screening involving protein C, Protein S, Antithrombin (chromogenic assays based on the inhibition of FIIa and FXa, antigen concentration), APC resistance, prothrombin mutation and Lupus anticoagulants was performed using standard laboratory methods. Genetic analysis of the SERPINC1 gene was done by direct sequencing.

RESULTS:

Thrombophilia screening showed isolated decreased AT activity at 21% (RR 80-120%). AT levels were retested and remained decreased (33-36%) on two consecutive occasions. SERPINC1 gene analysis revealed a previously described homozygous mutation (Budapest III) causing type IIB deficiency (c.391C>T; p.Leu131Phe). A family study confirmed the same mutation in both parents and three siblings. The patient improved significantly following warfarin therapy and over the past 2.5 years did not experience new thromboembolism.

CONCLUSIONS:

This case represents a rare combination of two risk factors provoking manifestation of spontaneous venous thromboembolism at a young age requiring permanent anticoagulant therapy.

• Authors: Sonata Saulytė-Trakymienė, Irina Adomaitienė, Susanne Unkrig, Johannes Oldenburg, Vytautas Ivaškevičius
• Journal: Hamostaseologie (Hamostaseologie) Vol. 37 Issue S 01 Pg. S26-S31 ( 2017) ISSN: 2567-5761 [Electronic] Germany
• Vernacular Title: Seltener Fall einer Venenthrombose bei einem jungen Patientenaus Litauen mit Antithrombin Typ IIB Mangel in Kombination mit einer Anomalie der Vena cava.
• PMID: 29582922 (Publication Type: Journal Article)
• Copyright: Schattauer GmbH.

Chemical References

• SERPINC1 protein, human
• Warfarin
• Antithrombin III

Topics

• Antithrombin III (genetics)
• Child
• Chromosome Aberrations
• DNA Mutational Analysis
• Genes, Dominant (genetics)
• Homozygote
• Humans
• Lithuania
• Liver (blood supply)
• Male
• Thrombophilia (blood, diagnosis, drug therapy, genetics)
• Vena Cava, Inferior (abnormalities)
• Venous Thromboembolism (blood, diagnosis, drug therapy, genetics)
• Warfarin (therapeutic use)