Unusual presentation of a sarcoid patient: multiple arterial and venous thrombosis with chest lymphadenopathy

• Published in: Journal of thrombosis and thrombolysis Vol. 28; no. 2; pp. 245 - 247
• Main Authors: Rebeiz, T. J., Mahfouz, R., Taher, A., Charafeddine, Kh, Kanj, N.
• Format: Journal Article
• Language: English
• Published: Boston Springer US 01.08.2009; Springer Nature B.V
• Subjects: Adult; Cardiology; Hematology; Humans; Lymphatic Diseases - etiology; Male; Medicine; Medicine & Public Health; Pulmonary Embolism - etiology; Sarcoidosis, Pulmonary - complications; Sarcoidosis, Pulmonary - diagnosis; Venous Thrombosis - etiology; Sarcoidosis; Thrombosis; Arterial
• ISSN: 0929-5305; 1573-742X
• DOI: 10.1007/s11239-008-0270-6

We depict a case of a 32 year old Mediterranean man, presenting with pulmonary embolism, and diffuse arterial thrombosis of the lower extremities. CT angiography revealed bilateral pulmonary artery occlusions and a mediastinal lymphadenopathy. Duplex Ultrasound of the lower extremities showed no deep venous thrombosis, but occluded popliteal arteries bilaterally with extension to the right distal superficial femoral artery. Mediastinoscopy with hilar lymph node biopsy showed noncaseating granulomas consistent with sarcoidosis. Thrombophilia profile revealed factor II, MTHFR, and factor XIII gene mutations with markedly elevated homocysteine level of 139 μmol/l. This is an atypical rare case of sarcoidosis presenting with pulmonary embolism and multiple arterial thrombosis.