Idiopathic myointimal hyperplasia of the mesenteric veins (IMHMV) is caused by proliferation of smooth muscle cells in the wall of small mesenteric veins and venules with accumulation of a proteoglycan matrix leading to a non-thrombotic, non-inflammatory venous occlusion resulting in venous ischemia. IMHMV is a rare and poorly understood disease, with <20 case reports in the literature. The purpose of this report is to describe the case of a 63-year-old man who presented with this condition that resulted in colonic ischemia necessitating surgical resection. The cause of IMHMV in this patient was attributed to a Chinese herbal supplement used for degenerative osteoarthritis of the knees. A brief review of the literature is provided along with the case report.
Protein C is a Vitamin K derivative that plays an essential role in anticoagulation. Protein C deactivates clotting factors Va and VIIIa; therefore, a deficiency in this protein leads to over expression and activation of these factors and essentially a hypercoagulable, prothrombotic state. Although studies have shown that the cardinal manifestation of protein C deficiency is venous thromboembolism, we present a case of a patient in his third decade with a myocardial infarction on a background of protein C deficiency and minimal cardiovascular risk factors. Similar cases of patients presenting with arterial thrombus on background of protein C deficiency have been reported; therefore, it is imperative to acknowledge protein C deficiency as a possible cause of acute, premature myocardial infarctions in young patients with minimal or no risk for cardiovascular disease.
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