Hypercoagulation in patient with ulcerative colitis associated with antiphospholipid syndrome and latent inherited thrombophilia after COVID-19: a clinical case

Abstract

Patients with ulcerative colitis exacerbation associated with COVID-19 infection represent a particular group who require additional attention and follow-up due to an increased risk of thrombosis. The article presents a clinical case of a patient born in 1971 with ulcerative colitis in association with antiphospholipid syndrome. Additionally the patient had a latent inherited thrombophilia, which activation was probably caused by exacerbation of ulcerative colitis. Nevertheless, there may have been additional triggering activity of a COVID-19 infection that the patient suffered before the exacerbation of ulcerative colitis. The patient usually had a fever in the morning during an exacerbation of ulcerative colitis. During current hospitalization, fever was also presented. To clarify the cause of the fever patient’s examination was performed. Infectious and inflammatory processes, neoplasms, connective tissue diseases were excluded. However, genetic testing revealed the presence of an increased risk of thrombosis in the patient (ITGA2 C/T, ITGB3 T/C were presented). At the same time, thrombotic masses in the portal vein, subtotal thrombosis of the right hepatic branch of the portal vein, thrombosis of the upper mesenteric vein up to 30%, lower mesenteric vein up to 70% were detected during ultrasound and computer tomography (CT) examination of the abdominal cavity. It should be noted that the management of patients with exacerbation of ulcerative colitis, especially with association with COVID-19 infection, requires an individual approach considering the risk assessment of thrombotic complications. Comprehensive examination is highly recommended, including genetic testing of patients in the clinical management of such patients.