Contributions
Abstract: PB2512
Type: Publication Only
Background
Behçet's disease is characterized by recurrent oral aphthous ulcers, genital ulcers, and uveitis. Involvement of large vessels, central nervous system, and gastrointestinal tract, and thrombotic events are less frequent but can be life threatening.
Aims
Here we report the therapeutic process as a case report of an 12 years old male patient presenting with neurological symptoms and diffuse venous thrombosis with Behçet's disease..
Methods
A 12 years old male patient with three days of fever was referred to our center, because of hepatomegaly, pleural effusion and persistent fever. In history; 3 years ago he applied to a hospital with double vision, inward shift in both eyes and bilateral papillary edema. Pseudotumor cerebri was diagnosed. Cranial MRI was re-evaluated, right sinus venous thrombosis was detected, thrombophilia screening was normal. Anticoagulant treatment was used for 1 year. In last 5 years, painful aphthous lesions occurred 3-10 times a year and were healing in 3-5 days. There was no similar disease in the family history. In physical examination; he had fever and tachypne. The skin was pale, right lung baseline respiratory sounds were decreased, and there was 1/6 systolic murmur on mesocardiac region. Superficial veins on the abdomen were apparent, liver was 5 cm palpable. Ampicillin sulbactam and clarithromycin was started for pneumonia-parapneumonic effusion. Abdominal USG was found normal except hepatomegaly. On the 10th day, pleural effusion was reduced, the fever persisted, the liver continued to grow, and the anemia deepened. After the diagnosis of thrombus in right atrium and vena cava inferior, treatment was changed to ceftriaxone and gentamicin with the diagnosis of infective endocarditis and unfractionated heparin was started. Abdominal and thoracic CT angiography was performed in terms of thromboembolism. Bilateral pulmonary embolism, infarct in parenchyma, filling defect in right atrium was observed. Vena cava inferior, bilateral iliac veins, vena porta, vena hepatica were obliterated. Liver perfusion deterioration and gall bladder hydrops were observed.
Results
The tissue plasminogen activator (tPA) was started at a dose of 0.3 mg/kg/h in addition to heparin upon approval from his family. Due to nosebleed dose was reduced to 0.25 mg/kg/hour, when the nosebleed stopped the dose was increased to 0.3 mg/kg/hour again. At the end of 16th hour, Doppler USG revealed normal in the portal vein, hepatic vein and vena cava inferior. At the 19th hour of tPA therapy, the thrombus in the right atrium was narrowed, but the thrombus continued in the vena cava inferior. On the second day of tPA treatment, upper gastrointestinal tract bleeding was observed in the patient. Erythrocyte suspension transfused, antacid and proton pump inhibitor started. On the 46th hour of the therapy thrombus in both the right atrium and the vena cava inferior was dissolved and then tPA and unfractionated heparin was terminated. The abdominal tendency disappeared, the veins on the abdominal wall have become silky and the liver has become smaller. Enoxiparin 1 mg/kg/dose was started at 12 hours interval. Methylprednisolone and azathioprine initiated. Anticoagulant treatment was changed to Coumadin.
Conclusion
In pediatric patients, tPA is the agent for thrombolytic upon approval from the parents. There is minimal experience with thrombolytic therapy in children. A survey showed no consensus in indications for thrombolysis, dose, mode of delivery, or duration of therapy. Thrombolytic therapy in patients is life saving for life or limb threatening diffuse thrombosis.
Session topic: 35. Thrombosis and vascular biology & translational Research
Keyword(s): Thromboembolism
Abstract: PB2512
Type: Publication Only
Background
Behçet's disease is characterized by recurrent oral aphthous ulcers, genital ulcers, and uveitis. Involvement of large vessels, central nervous system, and gastrointestinal tract, and thrombotic events are less frequent but can be life threatening.
Aims
Here we report the therapeutic process as a case report of an 12 years old male patient presenting with neurological symptoms and diffuse venous thrombosis with Behçet's disease..
Methods
A 12 years old male patient with three days of fever was referred to our center, because of hepatomegaly, pleural effusion and persistent fever. In history; 3 years ago he applied to a hospital with double vision, inward shift in both eyes and bilateral papillary edema. Pseudotumor cerebri was diagnosed. Cranial MRI was re-evaluated, right sinus venous thrombosis was detected, thrombophilia screening was normal. Anticoagulant treatment was used for 1 year. In last 5 years, painful aphthous lesions occurred 3-10 times a year and were healing in 3-5 days. There was no similar disease in the family history. In physical examination; he had fever and tachypne. The skin was pale, right lung baseline respiratory sounds were decreased, and there was 1/6 systolic murmur on mesocardiac region. Superficial veins on the abdomen were apparent, liver was 5 cm palpable. Ampicillin sulbactam and clarithromycin was started for pneumonia-parapneumonic effusion. Abdominal USG was found normal except hepatomegaly. On the 10th day, pleural effusion was reduced, the fever persisted, the liver continued to grow, and the anemia deepened. After the diagnosis of thrombus in right atrium and vena cava inferior, treatment was changed to ceftriaxone and gentamicin with the diagnosis of infective endocarditis and unfractionated heparin was started. Abdominal and thoracic CT angiography was performed in terms of thromboembolism. Bilateral pulmonary embolism, infarct in parenchyma, filling defect in right atrium was observed. Vena cava inferior, bilateral iliac veins, vena porta, vena hepatica were obliterated. Liver perfusion deterioration and gall bladder hydrops were observed.
Results
The tissue plasminogen activator (tPA) was started at a dose of 0.3 mg/kg/h in addition to heparin upon approval from his family. Due to nosebleed dose was reduced to 0.25 mg/kg/hour, when the nosebleed stopped the dose was increased to 0.3 mg/kg/hour again. At the end of 16th hour, Doppler USG revealed normal in the portal vein, hepatic vein and vena cava inferior. At the 19th hour of tPA therapy, the thrombus in the right atrium was narrowed, but the thrombus continued in the vena cava inferior. On the second day of tPA treatment, upper gastrointestinal tract bleeding was observed in the patient. Erythrocyte suspension transfused, antacid and proton pump inhibitor started. On the 46th hour of the therapy thrombus in both the right atrium and the vena cava inferior was dissolved and then tPA and unfractionated heparin was terminated. The abdominal tendency disappeared, the veins on the abdominal wall have become silky and the liver has become smaller. Enoxiparin 1 mg/kg/dose was started at 12 hours interval. Methylprednisolone and azathioprine initiated. Anticoagulant treatment was changed to Coumadin.
Conclusion
In pediatric patients, tPA is the agent for thrombolytic upon approval from the parents. There is minimal experience with thrombolytic therapy in children. A survey showed no consensus in indications for thrombolysis, dose, mode of delivery, or duration of therapy. Thrombolytic therapy in patients is life saving for life or limb threatening diffuse thrombosis.
Session topic: 35. Thrombosis and vascular biology & translational Research
Keyword(s): Thromboembolism