A Case of Multiple Episodes of Venous Thrombosis Causing Deep Vein Thrombosis, Cerebral Venous Sinus Thrombosis and Pulmonary Embolism in a Patient With Hyperhomocysteinemia

Venous thromboembolism, causing Pulmonary Embolism (PE), is one of the major cardiovascular causes of death. Hyperhomocysteinemia can increase the risk of pulmonary embolism. We are reporting a 30 year sedentary male presented with acute onset shortness of breath since the previous morning with chest discomfort, palpitations and perspiration with past history of superior sagittal sinus thrombosis causing non-haemorrhagic venous infarct and deep vein thrombosis of right lower limb. His serum homocysteine level was 42micromol/l (high) and D-Dimer with value of 3.2 (positive). The electrocardiogram showed S1Q3T3 pattern, low voltage pattern, poor progression of 'R' wave, resting tachycardia, heart rate of 160/min with 'P' pulmonale RV strain. Chest radiograph was showing Hamptons hump and Wistermark striae. The echocardiography RV dysfunction with RV apical sparing (positive Macuon sign) with PAP: 45 mmHg with LV diastolic dysfunction and LVAE of 56%. Considering clinical, laboratory parameters and imaging profile diagnosis of acute pulmonary embolism was considered in background of deep vein thrombosis (DVT) and hyperhomocysteinemia with past history of cortical venous sinus thrombosis. Patient was treated with fibrinolytic agent (streptokinase) and other standard supportive line of treatment and was discharged on oral anticoagulant, folate, vitamin B6 and vitamin B12 supplementations.