Publication: Protein S Deficiency with Recurrent Deep Vein Thrombosis and Post Thrombotic Syndrome: A Case Report
Date
2022
Article Type
Case Report
Journal Title
Journal ISSN
JNMA Print ISSN: 0028-2715; Online ISSN: 1815-672X
Volume Title
Pages
Pages: 892 - 894
Publisher
Nepal Medical Association
Abstract
Abstract
Protein S is a vitamin K-dependent protein that acts as a break in secondary hemostasis by inactivating activated factor V and activated factor VIII. We report a case of a 40 years old male who had the first episode of deep vein thrombosis of the left lower limb 10 years back, which despite treatment, reoccurred 3 months later in the bilateral lower limb. Thrombophilic screening showed severe protein S deficiency. The patient then developed deep vein thrombosis of both upper limbs. The patient was advised to place an inferior vena cava filter, which he denied. The patient is now presenting with multiple episodes of post-thrombotic syndrome. Such attacks are treated with elastic compression stockings, rivaroxaban, and morphine. However, despite medication, the pain has not yet subsided. Hence, even though protein S deficiency is the rare cause of deep vein thrombosis when recurrent should be considered despite its rare occurrence.
Description
Shashank Neupane
Nepalese Army Institute of Health Sciences, Sanobharyang, Kathmandu, Nepal
Prasamsa Pudasaini
Nepalese Army Institute of Health Sciences, Sanobharyang, Kathmandu, Nepal
https://orcid.org/0000-0002-5879-6107
Bishal Dhakal
Nepalese Army Institute of Health Sciences, Sanobharyang, Kathmandu, Nepal
Shila Awal
Department of Internal Medicine, Nepalese Army Institute of Health Sciences, Sanobharyang, Kathmandu, Nepal
Sajeena Thapa
Department of Internal Medicine, Nepalese Army Institute of Health Sciences, Sanobharyang, Kathmandu, Nepal
Binaya Subedi
Nepalese Army Institute of Health Sciences, Sanobharyang, Kathmandu, Nepal
Keywords
Deep vein thrombosis, protein S deficiency, rivaroxaban
Identifier
https://doi.org/10.31729/jnma.7694