Superior vena cava syndrome due to intravascular thrombosis in a patient with rheumatoid arthritis without antiphospholipid antibody syndrome: Is rheumatoid arthritis a separate hypercoagulable state

• Published in: Russian open medical journal Vol. 3; no. 1; p. 109
• Main Authors: Dharmshaktu, Pramila, Bhowmick, Jayeeta, Dhanwal, Dinesh
• Format: Journal Article
• Language: English
• Published: Limited liability company «Science and Innovations» (Saratov) 01.01.2014
• Subjects: rheumatoid arthritis; superior vena cava syndrome
• ISSN: 2304-3415; 2304-3415
• DOI: 10.15275/rusomj.2014.0109

We report a 60 year male with long history of joint pain later diagnosed as rheumatoid arthritis (RA) who presented with dyspnoea and swelling over neck& upper chest. A clinical diagnosis of superior vena cava (SVC) syndrome was made. Patient fulfilled criteria for definite rheumatoid arthritis supported with positive serology. Contrast enhanced computerized tomography (CECT) scan of chest revealed thrombosis in SVC. Patient was investigated for the cause of SVC thrombosis. Anti nuclear antibody (ANA) test was negative. Anti cardiolipin antibody was done to rule out antiphospholipid antibody (APLA) syndrome which has a known association with rheumatoid arthritis to cause intravascular thrombosis but was negative. Digital rectal examination (DRE) and prostate specific antigen (PSA) levels were normal. Further investigations as a part of thrombophilia work up were normal. There are case reports where RA is associated with SVC syndrome but only when it is associated mediastinal lymphadenopathy or SVC thrombosis due to APLA Syndrome. This case suggests RA per se as hypercoagulable state.