Hypercoagulability and Cavernous Sinus Thrombosis due to Protein C Deficiency. A Case Report

Authors

  • Wilson S. Peñafiel-Pallares Fifth-year Medical Student. School of Medicine, Universidad de las Américas, Quito, Ecuador. https://orcid.org/0000-0002-9896-6991
  • Camila Brito-Balanzátegui Fifth-year Medical Student. School of Medicine, Universidad de las Américas, Quito, Ecuador. https://orcid.org/0000-0001-8543-5406
  • Jaime David Acosta-España Medical Doctor, Reasercher, Ph.D. student. Institute of Microbiology, Friedrich Schiller University Jena, Jena, Germany. Senior Lecturer. Postgraduate Program in Infectious Diseases, School of Medicine, Pontificia Universidad Católica del Ecuador, Quito, Ecuador. Researcher. Centro de Investigación para la Salud en América Latina (CISeAL), Pontificia Universidad Católica del Ecuador, Quito, Ecuador https://orcid.org/0000-0001-5299-2732

DOI:

https://doi.org/10.5195/ijms.2023.1660

Keywords:

Thrombophilia, Protein C Deficiency, Cavernous Sinus Thrombosis, Case Report

Abstract

Background: Thrombophilia due to Protein C deficiency is a rare condition, present in 0.2% of general population. Cerebral venous thrombosis has an incidence of 3-4 cases per million in adults. A combination of both is very uncommon. Patients with these conditions are prone to life-threatening superinfections.

Case: A 51-year-old woman presented with pressing frontal headache accompanied with left periorbital edema, fever, diplopia, and disorientation. Laboratory findings showed low protein C levels. Computed tomography demonstrated sphenoidal rhinosinusitis. Magnetic resonance venography revealed cavernous sinus thrombosis. The patient was started on empiric antibiotic treatment (vancomycin, ceftriaxone, and metronidazole) and anticoagulants.

Conclusion: This case report emphasizes the importance of early diagnosis and appropriate management of patients with protein C deficiency complicated by septic cavernous sinus thrombosis.

Background: Thrombophilia due to Protein C deficiency is a rare condition, present in 0.2% of general population. Cerebral venous thrombosis has an incidence of 3-4 cases per million in adults. A combination of both is very uncommon. Patients with these conditions are prone to life-threatening superinfections.

Case: A 51-year-old woman presented with pressing frontal headache accompanied with left periorbital edema, fever, diplopia, and disorientation. Laboratory findings showed low protein C levels. Computed tomography demonstrated sphenoidal rhinosinusitis. Magnetic resonance venography revealed cavernous sinus thrombosis. The patient was started on empiric antibiotic treatment (vancomycin, ceftriaxone, and metronidazole) and anticoagulants.

Conclusion: This case report emphasizes the importance of early diagnosis and appropriate management of patients with protein C deficiency complicated by septic cavernous sinus thrombosis.

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References

Martinelli I, Passamonti SM, Bucciarelli P. Handbook of Clinical Neurology. 1st ed, Milan: Italy;2014.

Majid Z, Tahir F, Ahmed J, Bin Arif T, Haq A. Protein C Deficiency as a Risk Factor for Stroke in Young Adults: A Review. Cureus. 2020;12(3). DOI: https://doi.org/10.7759/cureus.7472

Danese S, Vetrano S, Li Z, Poplis VA, Castellino FJ. The protein C pathway in tissue inflammation and injury: Pathogenic role and therapeutic implications. Blood. 2010;115(6):1121–31. DOI: https://doi.org/10.1182/blood-2009-09-201616

Dinarvand P, Moser KA. Protein C deficiency. Arch Pathol Lab Med. 2019;143(10):1281–5. DOI: https://doi.org/10.5858/arpa.2017-0403-RS

Stam J. Thrombosis of cerebral veins and sinuses. N Engl J Med. 2005;352:1791–8. DOI: https://doi.org/10.1056/NEJMra042354

Ferro JM, Canhão P, Stam J, Bousser MG, Barinagarrementeria F. Prognosis of Cerebral Vein and Dural Sinus Thrombosis: Results of the International Study on Cerebral Vein and Dural Sinus Thrombosis (ISCVT). Stroke. 2004;35(3):664–70. DOI: https://doi.org/10.1161/01.STR.0000117571.76197.26

Bhatia H, Kaur R, Bedi R. MR imaging of cavernous sinus thrombosis. Eur J Radiol Open. 2020;(7):100226. DOI: https://doi.org/10.1016/j.ejro.2020.100226

Weerasinghe D, Lueck CJ. Septic Cavernous Sinus Thrombosis: Case Report and Review of the Literature. Neuroophthalmology. 2016;40(6):263–76. DOI: https://doi.org/10.1080/01658107.2016.1230138

Fukushima T, Shimomura Y, Nagaya S, Morishita E, Kawakami O. A Case of Treatment With Dabigatran for Cerebral Venous Thrombosis Caused by Hereditary Protein C Deficiency. Cureus. 2021;13(6):1–4. DOI: https://doi.org/10.7759/cureus.15473

Barshak MB, Durand ML. The role of infection and antibiotics in chronic rhinosinusitis. Vol. 2, Laryngoscope Investig. Otolaryngol. 2017;(1):36–42. DOI: https://doi.org/10.1002/lio2.61

Published

2023-03-31

How to Cite

Peñafiel-Pallares, W. S., Brito-Balanzátegui, C., & Acosta-España, J. D. (2023). Hypercoagulability and Cavernous Sinus Thrombosis due to Protein C Deficiency. A Case Report. International Journal of Medical Students, 11(1), 76–79. https://doi.org/10.5195/ijms.2023.1660

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Case Report

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