Early cerebral sinovenous thrombosis in a child with acute lymphoblastic leukemia carrying the prothrombin G20210A variant: a case report and review of the literature.
This paper describes the case of a male child with acute lymphoblastic leukemia who developed cerebral sinovenous thrombosis on day 6 of induction therapy with intrathecal methotrexate and methylprednisolone. A central venous catheter had been implanted the day before. The heterozygous prothrombin G20210A variant was found together with acquired activated protein C resistance and a reduced activated partial thromboplastin time. Clinical course and magnetic resonance imaging with magnetic resonance venography gradually improved over the following days after starting anticoagulant therapy (heparin and nadroparin). Cerebral sinovenous thrombosis is a serious disease in leukemic children, occurring in up to 6% of these patients. Data from the literature are in favor of anti-coagulant treatment, even though the efficacy and safety of thromboprophylaxis during chemotherapy in leukemic children with inherited thrombophilic conditions remain to be demonstrated.
Mazzoleni
Stefano
S
Maternity and Children's Department, Division of Pediatrics, Camposampiero Hospital, Padua, Italy.
Putti
Maria C
MC
Simioni
Paolo
P
Sainati
Laura
L
Tormene
Daniela
D
Manara
Renzo
R
Carli
Modesto
M
D020016:Activated Protein C Resistance / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000209:etiology; D019943:Amino Acid Substitution / Q000235:genetics; D001921:Brain / Q000000981:diagnostic imaging; D002675:Child, Preschool; D005343:Fibrinolytic Agents / Q000008:administration & dosage*; D006801:Humans; D008297:Male; D017762:Nadroparin / Q000008:administration & dosage*; D017354:Point Mutation; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000150:complications / Q000000981:diagnostic imaging / Q000188:drug therapy; D011516:Prothrombin / Q000235:genetics; D011859:Radiography; D012851:Sinus Thrombosis, Intracranial / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000209:etiology
D005343:Fibrinolytic Agents; D017762:Nadroparin; D011516:Prothrombin