[Portal and mesenteric thrombosis associated with protein S deficiency]

Area of Science:

• Hepatology
• Hematology
• Vascular Medicine

Background:

• Liver cirrhosis is the primary cause of portal thrombosis (PT).
• Hypercoagulability syndromes are infrequently identified as the etiology of PT.
• This case highlights a rare instance of PT secondary to protein S deficiency.

Observation:

• A 74-year-old woman presented with melena and abdominal pain, revealing ruptured esophageal varices.
• Imaging demonstrated extensive portal and mesenteric thrombosis, splenomegaly, ascites, and portosystemic collaterals.
• Liver biopsy suggested non-cirrhotic portal hypertension, prompting further investigation for hypercoagulability.

Findings:

• Protein S deficiency was diagnosed, with total pS at 107% and free pS at 56%.
• The patient received anticoagulant therapy, which successfully prevented additional thrombotic events.
• This case underscores the importance of investigating hypercoagulability in PT patients.

Implications:

• PT diagnosis necessitates a thorough evaluation for underlying hypercoagulability disorders.
• Protein S deficiency should be considered in the differential diagnosis of PT, even with suspected liver disease.
• Systematic screening for prothrombotic states improves patient outcomes in portal thrombosis management.