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Clinical lesson to not overlook venous thrombosis: a case of primary antiphospholipid syndrome
  1. Sryla Punjadath1,
  2. Mukul Aggarwal2,
  3. Gaurav Gupta1 and
  4. Upendra Baitha1
  1. 1Internal Medicine, All India Institute of Medical Sciences, New Delhi, India
  2. 2Clinical Hematology, All India Institute of Medical Sciences, New Delhi, India
  1. Correspondence to Dr Gaurav Gupta; docgaurav996{at}


A man in his early 30s presented to us with progressive shortness of breath limiting activities of daily living. An important clue in history was the episode of a deep vein thrombosis 5 years ago treated with short-term anticoagulation. His echocardiography revealed elevated estimated pulmonary artery systolic pressure. A CT pulmonary angiography confirmed chronic thromboembolic pulmonary hypertension. Blood investigations established primary antiphospholipid syndrome. He underwent pulmonary endarterectomy, relieving his symptoms and was started on indefinite oral anticoagulation with warfarin. He is currently under follow-up with no recurrence of thrombosis.

We wish to highlight the importance of an appropriate workup of venous thrombosis in all patients. Antiphospholipid syndrome is a rare disease with important implications in the management of patients with thromboses. The delay in his diagnosis had several causes including the unclear distinction between provoked and unprovoked thrombosis and socioeconomic factors in a developing nation limiting referral and testing.

  • Venous thromboembolism
  • Haematology (incl blood transfusion)

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  • Contributors The following authors were responsible for drafting of the text, sourcing and editing of clinical images, investigation results, drawing original diagrams and algorithms, and critical revision for important intellectual content: SP, MA, GG and UB. The following authors gave final approval of the manuscript: SP, MA, GG and UB.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Case reports provide a valuable learning resource for the scientific community and can indicate areas of interest for future research. They should not be used in isolation to guide treatment choices or public health policy.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.