SHM Converge Scientific Abstract ePoster Gallery-A Shocking Development: Ivc Thrombosis in Lupus Nephritis

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This case report highlights inferior vena cava (IVC) thrombosis as a rare but serious complication in patients with lupus nephritis and nephrotic syndrome. IVC thrombosis represents a small proportion of venous thromboembolism cases, but it can be difficult to diagnose because symptoms may overlap with those of nephrotic syndrome.<br /><br />The authors emphasize that clinicians should suspect IVC thrombosis in high-risk patients who present with unexplained pelvic or back pain, persistent edema despite diuretics, bilateral lower-extremity DVT, recurrent DVT or pulmonary embolism, or other thrombotic risk factors such as pregnancy or systemic lupus erythematosus. Even if lower-extremity duplex ultrasound is negative, IVC thrombosis should still be considered.<br /><br />CT venography and MRI are the preferred diagnostic studies. Treatment generally includes systemic anticoagulation, with catheter-directed fibrinolysis or mechanical thrombectomy in selected cases. Early recognition is important because delayed diagnosis can lead to life-threatening complications such as massive pulmonary embolism and obstructive shock.<br /><br />In this case, the patient was started on therapeutic enoxaparin. Workup for infection and antiphospholipid syndrome was negative, and treatment was adjusted from azathioprine to mycophenolate for lupus nephritis, with anticoagulation transitioned to apixaban. During outpatient follow-up, the patient showed marked improvement in edema and proteinuria.<br /><br />Overall, the report stresses the importance of maintaining a high index of suspicion for IVC thrombosis in patients with nephrotic syndrome or lupus nephritis, even when initial leg ultrasound is unrevealing.

Asset Subtitle

Maryam Hajiabbasi

Meta Tag

Author List Joonkyung Lee, Maryam Hajiabbasi, Nagma Shah, Nitzy Munoz Casablanca

Category Clinical Vignettes

Concept Inferior Vena Cava Thrombosis

Concept Anticoagulation

Concept Nephrotic Syndrome

Concept Hypercoagulable State

Concept Lupus Nephritis

Distinguished Non-Finalist

Presenter Organization Department of Medicine, NYC Health + Hospitals / Elmhurst, Icahn School of Medicine at Mount Sinai

Presenting Author Maryam Hajiabbasi

Track Adult

Keywords

inferior vena cava thrombosis

lupus nephritis

nephrotic syndrome

venous thromboembolism

deep vein thrombosis

pulmonary embolism

CT venography

MRI diagnosis

anticoagulation therapy

mycophenolate

Inferior Vena Cava Thrombosis

Anticoagulation

Nephrotic Syndrome

Hypercoagulable State

Lupus Nephritis