Endocrine Abstracts

Upper extremity deep vein thrombosis (UEDVT) is not infrequent and accounts for approximately 14% of deep vein thrombosis. The risk of pulmonary embolism is lower than in lower extremity DVT and prompt diagnosis is essential to select those patients who deserve anticoagulant treatment. Previous studies indicated that type 2 diabetes (DM) patients carried greater risk of DVT development or recurrence than the general population.

A 49-years old female, with no previous medical history, was admitted to our center via Emergency Room (ER) for optimizing glycemic control. At admission: altered general status, bradylalia, bradypsychia, generalized edema, marked fatigability, BP=140/90 mmHg, pulse=96 b/min, holosystolic murmur in the mitral area. Lab findings revealed: BG=401 mg/dl, glycosuria (1 g/dl), proteinuria (300 mg/dl), low serum iron, mild normochromic and normocytic anemia, high INR and NT proBNP levels, hypocalcaemia, low HDL cholesterol, slightly elevated CRP, cholestasis syndrome and A1c=14.01% was consistent with a sever glycemic imbalance in the last 3 months. Intravenous insulin infusion and few boluses were needed to correct the hyperglycemic values followed by initiation of a basal regimen with glargine insulin and metformin. On 3rd day since admission, edematous swelling and cyanosis of the right arm with collateral circulation at the shoulder girdle was observed. The echo-Doppler showed a massive thrombosis from brachial to the brachiocephalic and internal jugular vein and the CT pulmonary angiogram thrombi at the level of segmental arteries bilaterally. Treatment with LMWHs was initiated and the patient was transferred to the Cardiology department with a favorable outcome. The screening for thrombophilia emphasized hyperhomocysteinemia and a slightly elevated S protein activity.

Our case illustrates an extensive UEDVT and pulmonary embolism in a newly diagnosed type 2 diabetic patient. The modifications in the thrombophilia screening together with the hypercoagulable state induced by hyperglycemia might have led to the development of this extensive UEDVT.