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[Eltrombopag-associated bilateral internal jugular vein thrombosis presenting with visual impairment and marked
Asaki Tsuru1, Mariko Takata1, Asato Tsuji1
1Department of Neurology, Kita-harima Medical Center.
Abstract:
We report an 86-year-old man with immune thrombocytopenia (ITP) who developed bilateral internal jugular vein (IJV) thrombosis during treatment with eltrombopag (EPAG). He had experienced multiple cerebral infarctions over several months, but their cause had remained undetermined and warfarin therapy had been continued. Nine days before admission to our hospital, he developed visual impairment, and ophthalmologic evaluation revealed bilateral papilledema. He was admitted for further evaluation. Lumbar puncture demonstrated markedly elevated cerebrospinal fluid opening pressure (53 cm H2O), suggesting intracranial hypertension, and contrast-enhanced MR venography demonstrated bilateral sigmoid sinus thrombosis and bilateral IJV thrombosis. Although early thrombotic changes were retrospectively identifiable on plain MRI obtained at the previous hospital, the diagnosis was delayed because we did not initially recognize the possibility of EPAG-associated thrombosis, and visual impairment persisted despite treatment. In patients receiving EPAG, thrombotic complications should always be considered, and careful assessment of abnormal intraluminal venous signals on plain MRI is important for early diagnosis and therapeutic intervention.
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