Unusual suspect in a common diagnosis: think beyond ‘minimal’

Authors

  • Dhiya Varghese Department of Paediatrics, Pushpagiri Institute of Medical Sciences and Research Centre, Thiruvalla, Kerala, India
  • Carol S. Cherian Department of Paediatrics, Pushpagiri Institute of Medical Sciences and Research Centre, Thiruvalla, Kerala, India
  • Jithu Kurien Department of Nephrology, Pushpagiri Institute of Medical Sciences and Research Centre, Thiruvalla, Kerala, India
  • Reji Thomas Department of Nephrology, Pushpagiri Institute of Medical Sciences and Research Centre, Thiruvalla, Kerala, India
  • Jacob Abraham Department of Paediatrics, Pushpagiri Institute of Medical Sciences and Research Centre, Thiruvalla, Kerala, India

DOI:

https://doi.org/10.18203/2349-3291.ijcp20223431

Keywords:

Nephrotic syndrome, Venous thrombosis, Post COVID hypercoagulability

Abstract

Nephrotic syndrome is a glomerular disease commonly seen in paediatric population. The disease is characterized by a hypercoagulable state and risk of thromboembolic complications. Cerebral venous thrombosis (CVT) is a rare complication in children associated with nephrotic syndrome with an incidence of 0.67/100000 with very few case reports described. 12-year-old girl with steroid dependent nephrotic syndrome- minimal change disease, with a background of recent COVID-19 infection, presented with vomiting, headache, altered sensorium and an episode of generalized tonic clonic seizure. Diagnosis established by magnetic resonance imaging (MRI) brain and MR venogram which showed superior sagittal sinus thrombosis. Child was started on anticoagulant therapy, gradually recovered with no neurological sequelae. Thrombosis should be suspected in nephrotic syndrome with the added risk of hypercoagulable state associated with COVID-19 infection. Cortical vein thrombosis, even though rare, should be considered in any patient with nephrotic syndrome who presents with neurological signs or symptoms, especially in this era of COVID-19 pandemic. This highlights the importance of suspecting and recognizing post COVID hypercoagulability as a triggering factor for neurological complications. Thromboembolic events are rare in paediatric patients with COVID-19 infection, but a high index of suspicion should be maintained in children, particularly those with comorbidities.

Author Biographies

Dhiya Varghese, Department of Paediatrics, Pushpagiri Institute of Medical Sciences and Research Centre, Thiruvalla, Kerala, India

Postgraduate Resident, Department of Paediatrics, Pushpagiri Institute of Medical Sciences and Research Centre, Thiruvalla, Kerala.

Jacob Abraham, Department of Paediatrics, Pushpagiri Institute of Medical Sciences and Research Centre, Thiruvalla, Kerala, India

Professor and Head of the Department, Department of Paediatrics, Pushpagiri Institute of Medical Sciences and Research centre, Thiruvalla.

References

Meena AK, Naidu KS, Murthy JM. Cortical sinovenous thrombosis in a child with nephrotic syndrome and iron deficiency anaemia. Neurol India. 2000;48:292.

Torres RA, Torres BR, de Castilho AS, Honorato R. Venous sinus thrombosis in a child with nephrotic syndrome: a case report and literature review. Rev Bras Ter Intensiva. 2014;26(4):430-4.

Stroke. Available at: https://www.ahajournals.org/ doi/10.1161/str.0b013e31820a8364. Accessed on 24 October 2022.

Kenet G, Kirkham F, Niederstadt T, Heinecke A, Saunders D, Stoll M, et al. Risk factors for recurrent venous thromboembolism in the European collaborative paediatric database on cerebral venous thrombosis: a multicentre cohort study. Lancet Neurol. 2007;6(7):595-603.

Ichord R. Outcome in childhood cerebral venous thrombosis—new insights. Nat Clin Pract Neurol. 2008;4(1):16-7.

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Published

2022-12-27 — Updated on 2023-01-05

Issue

Section

Case Reports