Thrombosis in the portal venous system caused by hypereosinophilic syndrome: A case report

• Published in: Medicine (Baltimore) 2018-11, Vol.97 (48), p.e13425-e13425
• Main Authors: Lin, Jinfeng, Huang, Xiaoying, Zhou, Weihua, Zhang, Suyan, Sun, Weiwei, Wang, Yadong, Ren, Ke, Tian, Lijun, Xu, Junxian, Cao, Zhilong, Pu, Zunguo, Han, Xudong
• Format: Article
• Language: English
• Subjects: Arginine - analogs & derivatives; Clinical Case Report; Critical Illness; Drug Therapy, Combination; Fibrinolytic Agents - administration & dosage; Gastrointestinal Hemorrhage - etiology; Heparin - administration & dosage; Humans; Hypereosinophilic Syndrome - complications; Hypereosinophilic Syndrome - diagnosis; Hypereosinophilic Syndrome - physiopathology; Hypereosinophilic Syndrome - therapy; Male; Pipecolic Acids - administration & dosage; Plasma Exchange; Platelet Aggregation Inhibitors - administration & dosage; Portal System; Pulmonary Eosinophilia - etiology; Sulfonamides; Tissue Plasminogen Activator - administration & dosage; Tomography, X-Ray Computed; Urokinase-Type Plasminogen Activator - administration & dosage; Venous Thrombosis - diagnostic imaging; Venous Thrombosis - etiology; Young Adult
• ISSN: 0025-7974; 1536-5964
• DOI: 10.1097/MD.0000000000013425

Extensive thrombosis in the portal venous system caused by hypereosinophilic syndrome (HES) is rare, and there is no consensus on anticoagulant and thrombolytic treatments for arteriovenous thrombosis caused by HES. The clinical data of a patient with extensive thrombosis in his portal venous system (superior mesenteric, splenic, hepatic, and portal veins), renal artery thrombosis, and mesenteric thrombosis caused by HES with secondary gastrointestinal bleeding and intestinal necrosis were retrospectively analyzed. Before admission, his eosinophil count increased to 7.47 × 10/L, and HES had been confirmed via bone marrow cytology. The patient experienced fever, cough, abdominal pain, massive hematemesis, and hematochezia that developed in succession. Abdominal computed tomography showed portal vein and superior mesenteric vein thromboses. Hypereosinophilic syndrome; extensive thrombosis in the portal venous system; acute eosinophil-associated pneumonia; gastrointestinal bleeding; intestinal necrosis. The patient was first treated with methylprednisolone, plasma exchange/hemofiltration, and single or combined use of unfractionated heparin and argatroban for anticoagulation. He was also administered alteplase and urokinase, successively, for thrombolytic treatment. Once the thromboses finally disappeared, the patient underwent surgery to excise a necrotic intestinal canal. The thromboses disappeared with these treatments, and the patient recovered after the necrotic intestinal canal was excised. The clinical manifestations of HES are complex and varied, and this condition can cause severe and extensive arteriovenous thrombosis. Anticoagulation therapy and thrombolysis are necessary interventions, and appear to be safe and effective.