Portal Vein Thrombosis and Thrombocytopenia in Eosinophilic Granulomatosis with Polyangiitis: A Paradox?

Authors

• Frieda Wolf Department of Internal Medicine C, Emek Medical Center, Itzhak Rabin Blvd., Afula, Israel
• Karina Glick Department of Internal Medicine C, Emek Medical Center, Itzhak Rabin Blvd., Afula, Israel
• Mazen Elias Department of Internal Medicine C, Emek Medical Center, Itzhak Rabin Blvd., Afula, Israel
• Reuven Mader Division of Rheumatology, Emek Medical Center, Itzhak Rabin Blvd., Afula, Israel

friedawo@clalit.org.il

Keywords

Abstract

A 36-year-old woman with eosinophilic granulomatosis with polyangiitis (EGPA) presented with necrotic skin lesions and pulmonary infiltrates. There was eosinophilic vasculitis on skin biopsy, and substantial tissue eosinophilia in her bone marrow. She had unexplained worsening thrombocytopenia, which prompted a thrombophilia work-up. However, abnormalities in liver enzymes led to the extraordinary finding of portal vein thrombosis. Thrombocytopenia resolved with treatment with low molecular weight heparin. This case highlights the risk of hypercoagulability in eosinophilia specifically, and in EGPA. We suggest that thrombosis should be ruled out in all cases of EGPA.