Acute arterial thrombosis with antithrombin III deficiency in nephrotic syndrome: Report of a case

Nephrotic syndrome frequently causes venous thromboembolic complications. A rterial thrombosis has rarely been reported and is mainly observed in child ren. Only six cases of lower extremity arterial thrombosis in adults have b een reported in the literature. The outcome in these cases was unsatisfacto ry because of the high rates of limb loss and recurrence of thrombosis. We report successful treatment of a 39-year-old man who suffered from right lo wer extremity arterial thrombosis associated with decreased levels of serum antithrombin III. He was admitted to our hospital with severe pain in his right foot. No pulse was palpable in his right dorsalis pedis or posterior tibial arteries. His right foot was cold and mottled, with a reduced sensat ion and motor activity. The laboratory data revealed a serum total protein concentration of 3.9 g/dl and an albumin concentration of 1.5 g/dl. The coa gulation profile showed a fibrinogen level of 879 mg/dl and antithrombin II I value of 9.5%. Right lower extremity arteriography showed a complete occl usion of the right deep femoral artery and popliteal artery, and a filling defect in the common femoral artery. An emergency thrombectomy was performe d under general anesthesia. The patient was treated successfully, and surgi cal treatment was followed by anticoagulant therapy with 1 000 units of ant ithrombin III. A renal biopsy revealed histologic evidence of minimal chang e of glomerulonephritis. He was discharged 3 months later, and no recurrenc e of thrombosis has yet been observed.