rivaroxaban and Mesenteric-Vascular-Occlusion

Cytomegalovirus is a viral genus of the overarching family Herpesviridae, and is of particular importance because of its relevance to human disease. This association is predominantly due to human cytomegalovirus, a well-studied pathogen. In addition to the mononucleosis syndrome that can occur during acute cytomegalovirus viraemia, this virion has been recurrently implicated as a provoking factor for thromboembolic disease in the published scientific literature. As physicians increasingly forgo extensive laboratory investigation in the setting of clinical hypercoagulability, it has also become evident that in some circumstances whether or not a particular investigation alters clinical management is not necessarily the only important question. Viraemia as a provoking factor for thrombosis stands as such an example. The aim of this Grand Round is to further explore the role of cytomegalovirus as it pertains to thromboembolic disease, especially in the present era of viral-associated thromboembolism.

Topics: Abdominal Pain; Acute Disease; Adult; Anticoagulants; Cytomegalovirus Infections; Factor Xa Inhibitors; Female; Fever; Heparin; Herpesvirus 4, Human; Humans; Lymphocytosis; Mesenteric Vascular Occlusion; Mesenteric Veins; Rivaroxaban; Venous Thrombosis; Viremia

Topics: COVID-19; Humans; Mesenteric Artery, Superior; Mesenteric Vascular Occlusion; Mesenteric Veins; Peripheral Arterial Disease; Rivaroxaban; Thrombosis

Mesenteric vein thrombosis is a rare but potentially lethal cause of abdominal pain. It is usually caused by prothrombotic states that can either be hereditary or acquired. Testosterone supplementation causes an acquired prothrombotic state by promoting erythropoeisis thus causing a secondary polycythaemia. We report a case of a 59-year-old man with a history of chronic obstructive pulmonary disease (COPD) stage III, who presented with abdominal pain. Evaluation revealed an elevated haemoglobin and haematocrit, a superior mesenteric vein thrombosis on CT and a negative Janus kinase 2 mutation. The patient is currently being treated with 6 months of anticoagulation with rivaroxiban. Although a well-known side effect of testosterone is thrombosis, the present case is used to document in the literature the first case of mesenteric vein thrombosis due to secondary polycythaemia from Androgel in the setting of COPD.

Topics: Abdominal Pain; Diagnosis, Differential; Humans; Male; Mesenteric Vascular Occlusion; Mesenteric Veins; Middle Aged; Morpholines; Polycythemia; Rivaroxaban; Testosterone; Thiophenes; Tomography, X-Ray Computed; Venous Thrombosis