Psoriasis – a new cardiovascular risk factor? A case report of deep venous thrombosis in a psoriasis patient

Introduction: According to the literature, psoriasis is a frequent chronic skin disease that affects 2% of the population. Traditionally, psoriasis has been considered a disease that only affects the skin and joints, but recent studies have shown that it is a systemic inflammatory disorder that can be associated with various comorbidities. Although chronic inflammation is not considered a traditional CV risk factor, it is associated with a procoagulant state, the inflammatory cytokines modulating the coagulation cascade by potentiating procoagulant processes and inhibiting the anticoagulant and fibrinolytic pathways. In particular, psoriasis is associated with an increased risk of developing severe vascular events such as myocardial infarction, stroke, pulmonary thromboembolism
Case presentation: I will present the case of a 50-year-old, obese, known with vulgar psoriasis, with long evolution, in the period of exaggeration of the disease, which accuses pain accompanied by swelling of the right lower limb. The objective is to notice important edema of the limb, erythematous skin hot, psoriatic cutaneous lesions spread across the entire body surface. Biological-with inflammatory syndrome. Venous eco-doppler reveals thrombus at the right superficial femoral artery, extending to the saphenous level. Pulmonary thromboembolism is excluded in pulmonary artery CT angiography. Treatment with unfractionated heparin is initially initiated, but it is difficult to maintain APTTs within the therapeutic range, which is why the HGMM is progressing clinically favorable.
Based on the data presented, the diagnosis of deep venous thrombosis in a patient with long evolution of a chronic systemic inflammatory disease, namely generalized vulgar psoriasis, is outlined. Numerous epidemiological studies have highlighted the increased vascular risk among patients with chronic inflammatory diseases such as systemic lupus erythematosus, rheumatoid polyarticular, systemic vasculitis. Porsorysis in turn associates an increased risk of vascular events, including deep vein thrombosis, especially when joining other predisposing factors such as obesity, prolonged bed rest in the discussed case. Concomitant rash and venous thrombosis symptoms do not allow us to accu-rately assess whether the onset of psoriasis has favored the formation of thrombosis venous, the patient being in a lull for a few months, or if the vascular event was a triggering factor for psoriasis relapse. However, the occurrence of deep vein thrombosis in a patient with psoriasis, in the absence of other significant risk factors, confirms its etiology.
Conclusions: Recent studies have shown that psoriasis can be associated with various cardiovascular and metabolic disorders. The presence of common inflammatory pathways can provide an explanation for the association between psoriasis and cardiovascular comorbidities. Cardiovascular risk should be carefully established among patients with psoriasis. Additional investigations are needed to clarify the mechanisms underpinning the association of psoriasis with cardiovascular comorbidities and to define optimal regimens to reduce the risk of cardiovascular events. Also, adequate treatment of psoriasis can not only improve skin eruption but also decrease the risk and severity of cardiovascular and metabolic disorders.

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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