Trousseau Syndrome in a young patient – a case report

Introduction: We will present the case of a young female patient with recurring Trousseau syndrome under oral anticoagulation which leads to the diagnosis of ovarian cancer. Methods: 39 year old female patient, with no collateral history or pathological history, is admitted for pain and swelling of the right upper limb, symptoms which appeared in an apparent good health. Th e physical examination reveals asymmetry of the upper limbs, collateral thoracic circulation with local infl ammatory signs. Thus, a diagnosis of deep vein thrombosis (DVT) is suspected and confirmed by elevated D-dimer values and venous Doppler echography, which reveals thrombosis of the right subclavian and axillar veins. A screening for thrombophilia is performed (with negative results) before treatment with LMWH is initiated. The initial evolution of the patient is favorable and is discharged with the recommendation for continued oral anticoagulation home for at least 6 months. Results: 5 weeks aft er discharge the patient is readmitted, presenting with signs of DVT of the right calf and superficial thrombophlebitis of forearms, arms, left thigh and right jugular vein, symptoms which appeared during a correctly conducted oral anticoagulation. Considering the highly suggestive context for Trousseau syndrome, the investigation is directed towards fi nding the primary tumor and an abdomino-pelvic MRI is performed, revealing a tumor of the right ovary with malignant characteristics. The patient is referred to a surgery clinic, operated and the pathological examination states the final diagnosis: papillary serous ovarian adenocarcinoma. Long term therapy with LMWH is considered necessary and recommended, with a favorable outcome: no signs of thrombosis aft er 6 months. Conclusions: We presented the case of a patient in which recurrence of deep vein thrombosis and migratory superficial thrombophlebitis – Trousseau syndrome – under oral anticoagulation lead the investigation towards a diagnosis of ovarian cancer. Long-term therapy with LMWH was recommended for this patient, with a favorable outcome.

ISSN – online: 2734 – 6382
ISSN-L 1220-658X
ISSN – print: 1220-658X
The Romanian Journal of Cardiology is indexed by:
ESC search engine
CODE: 379
CME Credits: 10 (Romanian College of Physicians)