Physiological
hypercoagulability is a well-known condition in older populations, whereas
thrombosis, especially in renal veins, is a rare occurrence in teenagers. This paper presents a pediatric case of renal venous
infarction and
thrombosis.
Case Description: We report the case of an 11-year-old Chinese boy who presented with low back discomfort and was afraid to walk. Computed tomography (CT) revealed
thrombosis in his renal veins and inferior vena cava. He was being treated for severe refractory mycoplasma pneumoniae
pneumonia (MPP). He was treated with
rivaroxaban and
urokinase for
thrombosis, and
azithromycin for MPP. On day 2 after admission, his symptoms improved. Therefore, the dosage of
rivaroxaban was decreased from 10 to 5 mg twice per day. On day 3 after admission, enhanced CT revealed new
thromboses in the bilateral pulmonary trunks and arteries, inferior cava, right renal veins, bilateral common iliac veins, and internal iliac vein. The ultrasonography showed a strip hypoecho at the pulmonary artery bifurcation. All the above imaging suggested that antithrombotic
therapy was insufficient. His plasma
antithrombin (AT) III activity remained consistently low during hospitalization. The family history was re-examined and revealed that both his father and grandfather had experienced spontaneous pulmonary
thrombosis around the age of 30. He was diagnosed with acquired and inherited
thrombosis and inherited AT III deficiency. Following a medication regimen of
piperacillin-tazobactam for 1 week and
rivaroxaban (10 mg, twice daily), he was discharged and no
thrombosis and other side effects or complications occurred in the following 3 months.
Conclusions: This is a rare case of a teenager with inherited and acquired
hypercoagulability. For refractory MPP pediatric patients with
thrombosis, clinicians should consider whether hereditary factors, such as inherited AT III deficiency, are involved in
thrombosis.