Tracing medusa's signature: Uncovering tales of prothrombotic state

Hypercoagulable states can present with complex vascular manifestations, including rare inferior vena cava (IVC) thrombosis and intracardiac masses, often resulting in delayed diagnosis and adverse outcomes. We describe a 30-year-old female who initially presented with right leg swelling, later developing systemic symptoms such as anaemia and thrombocytopenia. Despite initial management for deep vein thrombosis, progressive clinical deterioration led to further evaluation, revealing hepatic IVC thrombosis with collateral circulation and a mitral valve mass consistent with Libman-Sacks endocarditis. A diagnosis of primary antiphospholipid syndrome was confirmed through serologic testing. She was successfully managed with anticoagulation, antiplatelet therapy and supportive treatment. This case underscores the need for comprehensive evaluation in patients with recurrent thrombotic events, emphasising the importance of early detection and sustained anticoagulation therapy to mitigate the risk of embolic complications and optimise long-term patient outcomes.