Central European Journal of Medicine Double-Trouble: An Unusual Case of Two Simultaneous Arterial Thromboses in Thrombophilia * E-mail: majadare@eunet.rs Received 25 August 2011; Accepted 29 September 2011 Abstract: Multiple arterial and venous thromboses are usually related to thrombophilia or antiphospholipid syndrome. Recurrent pulmonary embolism strongly indicates the presence of genetic or acquired thrombophilic factors. Simultaneous double arterial in situ thrombo- ses are unusual, even in thrombophilic conditions. Simultaneous occurrence of pulmonary embolism and cerebrovascular ischaemic insult are highly indicative of existence of patent foramen ovale. We present herein a patient with the double simultaneous arterial thromboses as the manifestation of thrombophilia (heterozygous for methylenetetrahydrofolate-reductase (MTHFR) C677T gene mutation). There was no patent foramen ovale suspected upon the patient`s admittance to hospital. To the best of our knowledge there have been no similar cases presented to date. © Versita Sp. z o.o. Keywords: Arterial thrombosis • Simultaneous thromboses • C677T methylenetetrahydrofolate reductase gene mutation • Therapy • Diagnosis 1 University Clinical Hospital Center Bezanijska Kosa, Department of Cardiology, 11000 Belgrade, Serbia 2 University Clinical Hospital Center Zemun, Department of Haematology, 11000 Belgrade, Serbia 3 Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia Mirjana Krotin 1,3 , Marija Zdravkovic 1,3* , Danica Popovic-Lisulov 1 , Jelena Saric 1 , Dusica Celeketic 2,3 , Mirna Zaja 1 , Darko Zdravkovic 1,3 Case report 1. Introduction Multiple arterial and venous thromboses are usually related to thrombophilia or antiphospholipid syndrome. Recurrent pulmonary embolism strongly indicates a presence of genetic or acquired thrombophilic factors [1]. Pulmonary embolism (PE) is usually a major clinical manifestation of venous thromboembolism [2], while in situ thrombosis in the pulmonary artery is rare and is most often related to an underlying thrombophilic condi- tion. Factor V Leiden (FVL), prothrombin gene mutation G20210A (FII G20210), genetic variant C677T of the methylentetrahydrofolate reductase (MTHFR), as well as the polymorphism A2 (PlA2) in platelet glycoprotein IIb/IIIa and antiphospholipid syndrome have recently been discussed as possible causes of recurrent throm- boses [3,4]. The C677T variant of MTHFR has recently also been suggested as a risk factor for venous and arterial thrombosis resulting in a thermo-stable, less active enzyme form [5]. Simultaneous double arterial in situ thromboses are unusual, even in thrombophilic conditions. Simultaneous occurrence of pulmonary embolism and cerebrovascu- lar ischaemic insult are highly indicative of existence of patent foramen ovale6. We present an unusual case of Cent. Eur. J. Med. • 7(1) • 2012 • 91-94 DOI: 10.2478/s11536-011-0110-5 91 Unauthenticated Download Date | 7/27/18 2:22 PM