¹Paul Etau Ekwom

¹Centre for rheumatic diseases

Introduction: To describe a 51 year old female with inferior vena cava thrombus (ivc) who was successfuly treated with infliximab.

Method(s): Review of records of patients seen over a 10-year period. Solitary case of behcet’s with IVC thrombus was identified. Other 7 cases of Behcet’s were also identified in a population of >10,000.

This a case description of a 51-year-old female, hairdresser

Result(s): Description of patient, 51-year-old female, hairdresser. Presented with shortness of breath, fatigue, recurrent and persistent painful oro-genital ulcers, and chest pain despite treatment with colchicine, azathioprine and prednisolone.

Tests done were negative or normal. ESR of, 18 mm/hr, normal total blood count and liver function tests, folic acid and ferritin. HIV/HCV/HBSAG: negative, VDRL/ HSV serologies: negative, ANA, ENA, DSDNA negative, normal complement c3 and c4, negative pathergy test. Malignancy screen and antiphospholipid antibodies were negative

She was on colchicine, azathioprine with reduction in ulcers. She had persistent dyspnea, low oxygen saturation 84% on room air, CT pulmonary angiogram  no pulmonary thromboembolism but was noted to have a filling defect in the IVC in keeping with IVC thrombosis.

She was initiated on anticoagulant in view of being on golimumab and concern about pulmonary microembolism with resultant dyspnea and hypotension. Her medication was changed to infliximab at 5mg/kg and administered as per schedule.

She had resolution of dyspnea and the orogenital ulcers and continues on her medication tht includes infliximab, colchicine and prednisolone 5 mgs daily

Conclusion(s):

Thrombosis in Behcet’s occurs in about 8-12% whereas vena cava thrombosis occurs  in about 4 -8.2%. Thrombosis include: deep vein thrombosis, superficial thrombophlebitis, vena cava thrombosis, pulmonary thromboembolism, cerebral venous thrombosis (CVT) , intracardiac thrombosis, Budd–Chiari syndrome (7.5%) and Renal vein thrombosis. Venous thrombosis is more frequent than arterial thrombosis, and multiple thrombosis is frequent.

Management of thrombosis includes: glucocorticoids and immunosuppressive such as azathioprine, cyclophosphamide or cyclosporine-A are recommended. Deep vein thrombosis is thought to result from inflammation of the vessel wall rather than hypercoagulability. For DVT, immunosuppressants alone are recommended. For other sites, anticoagulants have been used (caution: need to ensure no pulmonary aneurysm)