Masiv acute bilateral pulmonary embolism etiologic and therapeutic challenge

Introduction: Pulmonary embolism (PE) represents the third most frequent cause of cardiovascular death, after myocardial infarction and stroke, with an inciden-ce of 1-2/1000 persons. In the majority of cases, PE has multiple causes and frequently has a silent manifesta-tion, death being the first sign of the disease (30-50% of cases). Studies reveal that 1-2% of the patients with PE remain undiagnosed, despite multiple investigati-ons. Recent research showed that psoriasis which is a chronic inflammatory disease that mainly affects the skin and joint is associated with multiple comorbidities (hypertension, dyslipidemia, obesity) with an increa-sed risk of severe vascular/atherothrombotic events, thrombocyte activation, and hyperhomocysteinemia.

Methods: We’d like to present the case of 69 years old female, diagnosed with vulgar psoriasis for 15 years treated with local corticoids, stage 2 hypertension, dys-lipidemia and chronic vein insufficiency stage 4a CEAP which presented to the Emergency Department with a chief complaint of dyspnea and shortness of breath on exertion for the past 2 weeks. On admission, clinical and paraclinical examinations revealed signs of psoriasis, trophic skin disorders on lower limbs, and high values of fibrin degradation product with specific elec-trocardiography and echocardiogram modifications.

Results: Corroborating with radiological images, the scintigraphic aspect advocates for the presence of pul-monary thromboembolism. Due to the correlation of clinical and paraclinical findings, it is suspected a chro-nic repetitive pulmonary thromboembolism.

Conclusions: The particularity of this case is the dis-crepancy between the clinical manifestations and the degree of obstruction of the pulmonary arteries. This patient had multiple possible causes for PE one of them interestingly being the association of psoriasis disease, which though still not well-known mechanisms gene-rates a procoagulant status. Studies showed that immu-ne processes in this disease causes an increase in the relative risk of cardiovascular events by 25% and can increase the risk of thrombotic events in elderly female patients about 40%. Future studies are needed for the identification of possible cardiovascular complications which can determine a negative prognostic in these kinds of patients.

ISSN – online: 2734 – 6382
ISSN-L 1220-658X
ISSN – print: 1220-658X
The Romanian Journal of Cardiology is indexed by:
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CODE: 379
CME Credits: 10 (Romanian College of Physicians)
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