Tuberc Respir Dis.  2011 Aug;71(2):134-138. 10.4046/trd.2011.71.2.134.

A Case of Trousseau's Syndrome with Catastrophic Course Triggered by an Intravenous Injection

• Moon JY
• Kim SI
• Kwak H
• Song SY
• Kim IS
• Kim SH
• Kim TH
• Sohn JW
• Yoon HJ
• Shin DH
• Park SS

• KMID: 1846421
• DOI: http://doi.org/10.4046/trd.2011.71.2.134

Abstract

Trousseau's syndrome is an unexplained thrombotic event that precedes the diagnosis of an occult visceral malignancy or appears concomitantly with the tumor. Upper extremity deep vein thrombosis is prevalent in patients with a central venous catheter. Furthermore, a peripheral intravenous injection may cause upper extremity deep vein thrombosis as well. However, a deep vein thrombosis has not been reported in the form of Trousseau's syndrome with a catastrophic clinical course triggered by a single peripheral intravenous injection. A 48-year-old man presented with a swollen left arm on which he was given intravenous fluid at a local clinic due to flu symptoms. Contrast computed tomgraphy scans showed thromboses from the left distal brachial to the innominate vein. The patient developed multiple cerebral infarctions despite anticoagulation treatment. He was diagnosed with stomach cancer by endoscopic biopsy to evaluate melena and had a persistently positive lupus anticoagulant. After recurrent and multiple thromboembolic events occurred with treatment, he died on day 20.

Keyword

Upper Extremity Deep Vein Thrombosis; Antiphospholipid Syndrome; Stomach Neoplasms

MeSH Terms

Antiphospholipid Syndrome
Arm
Biopsy
Brachiocephalic Veins
Central Venous Catheters
Cerebral Infarction
Humans
Injections, Intravenous
Lupus Coagulation Inhibitor
Melena
Middle Aged
Stomach Neoplasms
Thrombosis
Upper Extremity Deep Vein Thrombosis
Venous Thrombosis
Lupus Coagulation Inhibitor

Figure

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  Figure 1 Axial scan of upper extremity CT angiography shows luminal expanding low attenuation thrombi (arrows) in the left subclavian vein. CT: computed tomography.

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  Figure 2 (A) Left upper extremity venogram shows occlusion of left subclavian and innominate vein due to intraluminal thrombi (arrows). There are collateral venous channels at lower neck. (B) Left upper extremity venogram obtained after overnight catheter directed thrombolysis shows restored flow through the left subclavian and innominate vein. Although small amount of intraluminal thrombi are still remained in the axillary vein, most of collaterals have disappeared.

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  Figure 3 Axial diffusion weighted magnetic resonance image shows high signal intensity foci suggesting acute infarct at right temporal, right frontal and left occiptial.

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  Figure 4 Endoscopy shows bleeding from gastric ulcer in the greater curvature of mid body. The ulcer was suspicous for advanced gastric cancer (Borrmann type II).

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