A case of protein S deficiency complicated with cerebral embolism and peripheral arterial embolism

doi:10.3969/j.issn.1674-8115.2022.10.019

Abstract

Abstract:

The patient, a 49-year-old male, was admitted to Zhoushan Hospital Affiliated to Wenzhou Medical University in January 2022. He complained of walking instability without obvious inducement for more than 1 month. He had a history of thrombophlebitis and no family history of arterial or venous thrombosis. He had two episodes of acute cerebral infarction, and the tests for thrombophilia in Ruijin Hospital, Shanghai Jiao Tong University School of Medicine showed that the total amount of protein S was 26.7%, and he had a heterozygous mutation C.1955A>T, p.Asp652Val in the exon 15 of PROS1 gene. Then he was diagnosed as having hereditary protein S deficiency (PSD), and thereafter he was given long-term oral rivaroxaban tablets for anticoagulation. This time the physical examinations showed no abnormalities except slightly unsteady walking. The patient scored 6 points in the Venous Thromboembolism (VTE) Risk Assessment Scale (Padua model) with high risk of VTE. Holter testing showed sinus rhythms with occasional premature atrial beats and premature ventricular beats. B-ultrasound for the vessels in the extremities showed multiple thrombus formation with local stenosis in the bilateral popliteal arteries and the posterior tibial arteries, and occlusion in the right radial artery. Echocardiography and carotid ultrasound showed no obvious abnormalities. Cranial MRI showed an old cerebral infarction lesion in the left basal ganglia region. CT angiography combined with three-dimensional reconstruction showed severe stenosis and possible occlusion in the M1 segment of the left middle cerebral artery, and stenosis and sclerosis of the siphon segment of the bilateral internal carotid arteries. Finally, the patient was diagnosed as having PSD with cerebral infarction and peripheral arterials obstruction. He was treated with rosuvastatin calcium for stabilizing plaques, rivaroxaban for anticoagulation, metoprolol succinate for controlling ventricular rhythms, and folic acid for improving metabolism. After 10 d of treatment, the patient 's symptoms were improved.

Key words: protein S deficiency (PSD), thrombophilia, cerebral infarction, artery occlusion

CLC Number:

R559

LÜ Mingshun, ZHANG Zihong, WANG Mei. A case of protein S deficiency complicated with cerebral embolism and peripheral arterial embolism[J]. Journal of Shanghai Jiao Tong University (Medical Science), 2022, 42(10): 1511-1516.

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References 17

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