Ann Rehabil Med.  2012 Jun;36(3):414-417. 10.5535/arm.2012.36.3.414.

Multivessel Thromboembolism Associated with Dysfunction of Protein S

• Ok EJ
• Kim HW
• Kim SD
• Park KS
• Kim YS
• Kim HM
• Lim SH

• KMID: 2266750
• DOI: http://doi.org/10.5535/arm.2012.36.3.414

Abstract

Protein S is a vitamin K-dependent coagulation factor that acts as an anticoagulant. Deficiency of protein S increases the risk of thromboembolic events. We report a case of isolated protein S deficiency in a 39-year-old woman suffering arterial occlusion in both lower legs. She underwent a surgical procedure using thrombectomy and balloon angioplasty of her left lower extremity. Later, she had right trans-tibial amputation because of the reperfusion injury. Throughout the evaluation of thromboembolic events, we diagnosed a large thrombus in the right atrium and an asymptomatic pulmonary thromboembolism. The patient was successfully treated with right atrial thrombectomy and systemic anticoagulation. Careful evaluation for protein S levels may be necessary in patients with arterial thromboembolic events, especially young adults.

Keyword

Protein S; Thromboembolism; Trans-tibial amputation

MeSH Terms

Adult
Amputation
Angioplasty, Balloon
Blood Coagulation Factors
Female
Heart Atria
Humans
Leg
Lower Extremity
Protein S
Protein S Deficiency
Pulmonary Embolism
Reperfusion Injury
Stress, Psychological
Thrombectomy
Thromboembolism
Thrombosis
Vitamins
Young Adult
Blood Coagulation Factors
Protein S
Vitamins

Figure

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  Fig. 1 On the day of arrival in the hospital, pedal gangrenous change and ischemia had progressed to the distal third of the right leg and whole foot.

• 

  Fig. 2 Lower extremity 3D CT showed occlusions in right superficial femoral, popliteal arteries and total occlusion below the knee.

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  Fig. 3 (A) Heart MRI showed a calcified thrombi in apex of the right ventricle (arrow) and in IVC (arrowhead), near the atriocaval junction. (B) Coronary artery CT showed low density thromboses in proximal left inferior pulmonary artery.

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