Trousseau’s syndrome with arterial thrombosis and venous thromboembolism in a patient with ovarian cancer

Background: Trousseau syndrome (TS), first described in 1865 refers to coagulopathy associated with underlying malignancy. It is the second leading cause of death among cancer patients. Deep vein thrombosis and superficial thrombophlebitis are the common manifestations of TS while arterial thrombosis is seen rarely. We present a patient with TS presenting with concomitant arterial and venous thrombosis.

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Case presentation: A 73 years old otherwise healthy lady presented with swelling of right lower limb with gangrenous toes. Investigations revealed right lower limb Deep Vein Thrombosis (DVT) and arterial thrombosis with underlying ovarian malignancy. Her investigation findings excluded paradoxical embolism, vasculitis and other thrombotic conditions. Surgical resection of the tumor was done, but attempted inferior vena caval filter insertion failed. Postoperatively, she developed pulmonary embolism, which was managed with anticoagulation. Unfortunately she developed ascending gangrene of the right leg with fatal sepsis.

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Conclusion: Concomitant arterial and venous thrombosis is a rare manifestation of TS. It is important to suspect underlying occult malignancy in patients presenting with arterial or venous thrombosis.