Massive Pulmonary embolism associated with hemorrhagic colitis: what is the link? A case report

Abstract

Tittle: Deep vein thrombosis in the lower limbs and pulmonary embolism are the most common thromboembolic phenomena in patients with inflammatory bowel disease. The inflammatory and thrombotic processes are connected, creating a vicious circle. Inflammation is at least implicated in maintaining the inflammatory process in ulcerative colitis and Crohn's disease. Many factors have been investigated as determinants of the pro-thrombotic tendency such as acquired risk factors or genetic and immune abnormalities, but a unique cause has not been found. Background: We felt that this case was of interest due to the rarity of the condition and the therapeutic challenge given the high risk of bleeding and the management of anti-inflammatory and immunological treatment. Case presentation: We describe the rare case of a patient with ulcerative colitis who suffered a massive pulmonary embolism that caused shock. Despite the therapeutic challenge and the high risk of hemorrhagic complications given the underlying disease, thrombolytic treatment was administered with a good result. Conclusion: Autoimmune disorders in general should be regarded not only as inflammatory disorders, but also as hyper-coagulable disorders. This clinical observation can put the item on the necessity of establishing recommendations for prevention of embolic events in patients with hemorrhagic colitis.