Massive Pulmonary Embolism Dominating Initial Presentation of Nephrotic Syndrome- A Case Report

Hypercoagulability is a well-recognised feature of Nephrotic Syndrome (NS) and may manifest clinically in the form of Renal Vein Thrombosis (RVT), Deep Vein Thrombosis (DVT) and Pulmonary Embolism (PE); these may uncommonly be among the presenting features of the syndrome. Prompt recognition and management requires that patients with NS should be followed with a high index of suspicion for thromboembolism. Here, the authors report a case of 35-year-old male patient who, while under evaluation for proteinuria, presented with massive PE. He was eventually diagnosed with primary Membranous Nephropathy (MN); a cause of NS with the highest associated risk of thromboembolism. The patient was managed with mechanical ventilation, anticoagulation and supportive care. He also received Rituximab during hospital stay. He was discharged in stable condition on apixaban and advised close follow-up.