PB0439 - Deep vein thrombosis in a celiac patient is complicated by her anti-phospholipid antibody.

Sunday, June 25, 2023

18:30 – 19:30 ET

Room: Exhibition

Co-Author(s)

YASMINA CHHIH, specialist in internal medicine

Doctor
internal medicine. Faculty of medicine. University Mohamed V. RABAT.MOROCCO
RABAT, Rabat-Sale-Zemmour-Zaer, Morocco

Co-Author(s)

WA

WAFA AMMOURI

Professeur
internal medicine.Faculty of medicine.University Mohamed V. Rabat.Morocco
RABAT, Rabat-Sale-Zemmour-Zaer, Morocco
bs

belkhettab sami

Professeur
internal medicine.Faculty of medicine.University Mohamed V. Rabat.Morocco
RABAT, Rabat-Sale-Zemmour-Zaer, Morocco
KH

KHIBRI HAJAR

Professeur
internal medicine.Faculty of medicine.University Mohamed V. Rabat.Morocco
RABAT, Rabat-Sale-Zemmour-Zaer, Morocco
MM

MOUNA MAAMAR

Professeur
internal medicine.Faculty of medicine.University Mohamed V. Rabat.Morocco
RABAT, Rabat-Sale-Zemmour-Zaer, Morocco
HH

Hicham HARMOUCHE

Prof.Dr
Internal medicine, Ibn Sina University Hospital Center, University Mohammed V, Rabat, Morocco
Rabat, Rabat-Sale-Zemmour-Zaer, Morocco

Presenting Author(s)

ZOUBIDA TAZI MEZALEK, MD (she/her/hers)

Professeur
Internal medicine - Clinical Hematology. Faculty of medicine.University Mohamed V. Rabat.Morocco
RABAT, Rabat-Sale-Zemmour-Zaer, Morocco

Background: Venous thromboembolic disease is multifactorial pathology with high morbidity and mortality. Celiac disease, anti phospholipid syndrome and protein C deficiency are all high thrombogenic risk conditions.

Aims: We report a case of complicated deep vein thrombosis in celiac patient revealing an association of anti phospholipid syndrome and protein C deficiency.

Methods: case report

Results: 30-year-old female patient, known to have celiac disease since the age of 19 under diet alone and having cousin with thalassemia. She was admitted for left ilio femoro popliteal deep vein thrombosis confirmed by venous Doppler ultrasound, put on anti Xa and compression stockings, but complicated one month later with unilateral proximal pulmonary embolism.
The clinical examination was unremarkable. The assessment showed iron deficiency microcytic anemia with hemoglobin at 7.5 g/dl and ferritin at 3 ng/ml. The rest of the malabsorption assessment, renal and hepatic function and inflammatory assessment were without abnormality
The thrombophilia assessment showed a protein C deficiency. The circulating lupus anticoagulant is positive, confirmed 12 weeks apart with negative anti-cardiolipin, anti-beta2glycoprotein and negative anti-nuclear antibodies.
Hemoglobin electrophoresis showed heterozygous alpha thalassemia.
The patient was therefore put on anticoagulant treatment of the anti-vitamin K type with maintenance of long-term compression stockings, folic acid, injectable iron and gluten-free diet.

Conclusion(s): Celiac disease is an enteropathy characterized by malabsorption related to gluten intolerance and immune-mediated pathogenesis.
The risk of occurrence of thrombotic manifestations in celiac disease is explained by hyperhomocysteinemia, vitamin B 12 and folate deficiency, genetic predisposition (MTHFR mutations) and Cet S protein deficiency. Being an autoimmune disease, it is associated with various other immune disorders with high thrombogenic potential such as anti phospholipid syndrome.