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A case of upper extremity thrombosis in patient with ulcerative colitis.

A 58-year-old man with UC was admitted with acute onset pain along with swelling of the left upper extremity and left side of the neck. Doppler ultrasound of the left upper extremity and neck revealed extensive thrombosis (Figure 1). Routine blood tests gave normal results except for a high erythrocyte sedimentation rate, C-reactive protein, hyperfibrinogenemia, anemia, and a significantly elevated level of lipoprotein(a) (90.5 mg/dL). A thrombophilia work-up including antiphospholipid antibody, lupus anticoagulant, homocysteine, factor VIII, D-dimer, fibrinogene, proteins C and S, antithrombin III, PT G20210A, factor V Leiden (FVL) and methylene tetrahydrofolate reductase (MTHFR) were performed. The work-up was negative except for a high level of homocystein (80 mg/dL). Genetic evaluation showed heterozygous for FVL and PT gene mutations and homozigosity for the mutation C677T of the MTHFR gene. The patient was admitted to the hospital and started on low molecular weight heparin. The patient’s left arm oedema improved gradually and he had no complaints after the third month of treatment.