Portal vein thrombosis associated with psoriasis: a case report

Abstract

BackgroundPsoriasis is no longer viewed as an isolated dermatological ailment and instead is considered a systemic disease. The extension of this spectrum has heightened the known risk of morbidity and mortality due to the involvement of cardiovascular system and the risk of venous thrombosis. A number of cases have reported the increased occurrence of deep vein thrombosis and pulmonary embolism in the background of psoriasis, however portal vein thrombosis has not been reported to date. We report an index case of chronic portal vein thrombosis in a diagnosed patient with psoriasis.Case presentationA 67-year-old South-Asian female previously diagnosed and treated for psoriasis presented with a four month history of abdominal pain associated with abdominal distension. Clinical examination revealed an enlarged spleen and free fluid in the abdomen. Imaging with ultrasonography and computed tomography of the abdomen revealed features compatible with chronic portal vein thrombosis with cavernous transformation.ConclusionThis case highlights the importance of having clinical awareness of occurrence of thrombosis in patients with psoriasis. Typical symptoms favoring thrombosis should prompt thorough investigation to exclude this rare yet possible complication in patients with psoriasis, including that of portal vein thrombosis. Prophylaxis with anticoagulation still lacks strength of evidence to be justified in psoriasis. The exact pathogenesis of venous thromboembolism in psoriasis is still unexplained and further studies are needed to clarify the causal association.

Development of venous thromboembolism in an elderly man with plaque psoriasis and antiphospholipid syndrome: A case report

“…However, a 2008 study has shown that aPL levels were not increased among patients with plaque psoriasis as compared to healthy controls 4 . Similar to the case we presented, there is a reported case of a patient with psoriasis and APS developing portal vein thrombosis 5 . Additionally, there are several case reports on APS in patients with psoriasis associated with infliximab and adalimumab 6,7 .…”

“…4 Similar to the case we presented, there is a reported case of a patient with psoriasis and APS developing portal vein thrombosis. 5 Additionally, there are several case reports on APS in patients with psoriasis associated with infliximab and adalimumab. 6,7 APS prevalence in patients with psoriasis diagnosed with VTE remains unknown because psoriasis 8 and its common comorbidities are well-known risk factors of VTE, which may preclude physicians from screening for aPL.…”

Psoriasis as a risk factor of pulmonary embolism - case report

“…Others suggested that psoriasis was an immune inflammatory disease characterized by T helper -Th1 and Th17-driven inflammation with a striking overlap of inflammatory markers and mediators with atherosclerosis [9][10][11] . Also, hyperhomocysteinemia, which may be associated with atherothrombosis and VTE 11 , was reported in the psoriatic patients [12][13][14] . The relationship between chronic inflammatory diseases (psoriasis, psoriatic arthritis and rheumatoid arthritis) was evaluated in a cohort study which was conducted in a primary care medical record database in the UK with the data from 1994-2014.…”

Complete Aortic Endograft Occlusion in a Patient with Psoriasis: A Case Report and Systematic Review of the Literature Seeking for a Potential Causal Association

“…Furthermore, we have identified 2 experimental mouse model studies that have associated psoriasis with arterial thrombotic occlusion [20] and with aortic root inflammation and thrombosis [21]. Finally, 2 cases-reports [22,23] were also included in this systematic review pointing to the need of clinical awareness of occurrence of thrombosis and pulmonary embolism in patients with psoriasis.…”