A 24‐year‐old woman 25 weeks' pregnant with a history of nephrotic syndrome was admitted for diabetic ketoacidosis and pneumonia. On day 4, she delivered a nonviable fetus, which was followed by flash pulmonary edema due to an inferior‐wall MI. Cardiac catheterization was suggestive of right coronary artery embolus. On day 8, she developed left upper quadrant abdominal pain and was found to have splenic infarct and bilateral iliac vein thrombi. Personal and family history of coagulation disorder was negative. She was then started on heparin infusion. During the course she developed progressive thrombocytopenia and worsening renal failure. However, liver function tests were normal. Blood, urine, and sputum cultures were sterile. Lupus anticoagulant, anticardiolipin antibody, beta 2 glycoprotein, heparin‐induced platelet antibody, hemolytic, and DIC panel were negative. CD 55/CD 59 assays, homocysteine, anti‐thrombin III, protein C, and protein S were nonrevealing. Prothrombin gene and factor V Leiden mutations were also negative. On day 15, her course was further complicated by multiple embolic strokes, as seen on CT scan. Continued anticoagulation for 3 months led to recovery of her symptoms with minimal residual neurological deficit.
Thrombotic storm progresses rapidly within a short period, with clots affecting multiple organ systems. Catastrophic antiphospholipid syndrome, heparin‐induced thrombocytopenia, and paroxysmal nocturnal hemoglobinuria should be excluded before making the diagnosis. Usual triggers of thrombotic storm include pregnancy, inflammation, trauma, surgery, and infection. It is often lethal if not detected and treated quickly. Continued anticoagulation therapy usually controls thrombotic storm.
Thrombotic storm presents as a serial thrombotic events that escalates rapidly involving multiple sites. The early diagnosis and initiation of anticoagulation measure is the key in the management.
To cite this abstract:Badal M. A Case of Thrombotic Storm, Wolf at the Door. Abstract published at Hospital Medicine 2013, May 16-19, National Harbor, Md. Abstract 320. Journal of Hospital Medicine. 2013; 8 (suppl 2). https://www.shmabstracts.com/abstract/a-case-of-thrombotic-storm-wolf-at-the-door/. Accessed April 4, 2020.