Abstract

A 53 year-old male patient was admitted to the Emergency Department for right-sided chest pain of one week duration. A linear atelectatic band parallel to the hemidiaphragm in the right lower zone and an obliterated costophrenic sinus were observed in his chest radiograph. His D-dimer level was found to be high (1224 ng/ml). Acute thrombosis in the right lower and upper pulmonary artery segmental branches were demonstrated on pulmonary angio-CT. Heparin infusion was started and Coumadin was added to the treatment on the third day. Pernicious anemia, vitiligo and chronic atrophic gastritis with antiparietal cell antibody were recorded in the patient’s medical history. Laboratory investigations revealed anemia due to Vit 12 deficiency. Serum homocystein was high (133 mm/L) and urinary homocystein was positive. In addition, Factor V G1691A (Leiden), Factor XIII V34L, ß-Fibrinogen-455 G-A, MTHFR C677T and MTHFR A1298C heterozygotic mutations were detected. We concluded that hyperhomocysteinemia secondary to megaloblastic anemia together with inherited prothrombotic risk factors were considered to facilitate venous thromboembolism in the present patient.