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2018 ; 25
(ä): 33-35
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Pulmonary embolism and deep vein thrombosis in eosinophilic granulomatosis with
polyangiitis successfully treated with rivaroxaban
#MMPMID29998056
Naito T
; Hayashi H
; Kashiwada T
; Saito Y
; Abe S
; Kubota K
; Gemma A
Respir Med Case Rep
2018[]; 25
(ä): 33-35
PMID29998056
show ga
A 41-year-old woman presented complaining of cough and purpura for one month. On
her first visit, a blood test demonstrated peripheral blood eosinophilia, but
chest radiography showed no abnormalities. However, 2 days after the first visit,
she went to the emergency room because of fever and right-sided chest pain.
Contrast-enhanced computed tomography of the chest showed pulmonary embolism and
air space consolidation. Thrombosis was present in the popliteal vein.
Bronchoscopy revealed alveolar hemorrhage and increased eosinophils in the
bronchoalveolar lavage fluid, and a skin biopsy demonstrated a perivascular
eosinophilic infiltrate. The patient was diagnosed with eosinophilic
granulomatosis with polyangiitis (EGPA). We started steroid therapy and
low-molecular-weight heparin (LMWH). The chest pain and fever disappeared, and
the peripheral eosinophil count normalized. However, the thrombosis in the leg
worsened. It was dramatically improved by changing from LMWH to oral rivaroxaban.
The thrombogenic risk of eosinophilia should be recognized. This case suggests
that oral rivaroxaban is useful when thrombosis is uncontrolled by LMWH in a
patient with EGPA.