Upper Arm Deep Vein Thrombosis in a Patient with Active Lupus

Area of Science:

• Rheumatology
• Vascular Medicine
• Internal Medicine

Background:

• Upper extremity deep vein thrombosis (UEDVT) is uncommon, particularly as an initial presentation of systemic lupus erythematosus (SLE).
• SLE is a chronic autoimmune disease affecting women of childbearing age, increasing thrombosis risk, typically in the legs.
• UEDVT is an unusual manifestation of SLE, even in patients with antiphospholipid antibodies.

Purpose of the Study:

• To highlight idiopathic UEDVT as a potential early indicator of SLE.
• To emphasize the importance of thorough investigation for underlying autoimmune conditions in cases of spontaneous unilateral arm swelling.
• To discuss the initial management of UEDVT and lupus nephritis in the absence of antiphospholipid syndrome.

Main Methods:

• Case presentation of a 36-year-old female with unilateral arm swelling.
• Diagnostic workup including Doppler ultrasound and CT scan with contrast for UEDVT.
• Comprehensive investigations leading to the diagnosis of SLE and exclusion of antiphospholipid syndrome.

Main Results:

• The patient was diagnosed with left UEDVT, which subsequently led to the diagnosis of SLE.
• Antiphospholipid syndrome was ruled out as a cause for thrombosis.
• The patient developed lupus nephritis and was treated with anticoagulants and high-dose steroids, with a postponed kidney biopsy due to bleeding risk.

Conclusions:

• Idiopathic UEDVT can be an early sign of SLE, necessitating a high index of suspicion and multidisciplinary investigation.
• Standard anticoagulants and steroids may be appropriate initial treatment for UEDVT and lupus nephritis.
• Kidney biopsy may be deferred in patients with high bleeding risk due to anticoagulation therapy.