Thrombophlebitis migrans including Mondors’ syndrome and autoimmune hemolytic anemia in ulcerative colitis; case report and review of the literature

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Annals of Gastroenterology
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Thrombophlebitis migrans including Mondors’ syndrome and autoimmune hemolytic anemia in ulcerative colitis; case report and review of the literature (EN)

Margarita Kitsanou, G. Kalambokis,Svetlana Leonidi, E.V. Tsianos, K.H. Katsanos, D.K. Christodoulou,

SUMMARY Thromboembolic events occur in UC and Crohn’s disease. Activation of clotting factors and thrombocytosis are common. In ulcerative colitis, increased levels of factor V, factor VIII and fibrinogen and decreased levels of antithrombin III have been demonstrated. Deep vein thrombosis and pulmonary emboli affect patients with severe disease and may occur after colectomy. Thromboembolic events in the eye or intracranial vessels have been described. Coombs positive hemolytic anemia has occasionally been reported in patients with ulcerative colitis. In some of these rare cases, hemolytic anemia was the main problem of the patient and was cured by colectomy. A case of a young female patient with ulcerative colitis, autoimmune hemolytic anemia, recurrent deep vein thromboses including Mondors’ syndrome and menstrual abnormalities is reported. There are several convincing reports that associate UC with Coombs positive hemolytic anemia and this co-existence should be considered in every UC patient with persisting or severe anemia. Before relating autoimmune anemia to UC, other causes of hemolysis should be excluded.The treatment of persistent autoimmune hemolytic anemia in UC patients could probably include administration of cyclosporine as there is a report of improvement of anemia after weeks of treatment. Methotrexate or azathioprine are alternative agents. Anti-influenza vaccination should invariably be performed in all IBD patients treated with immunosuppressive agents. Steroids should not be withdrawn or administered at reduced doses in cases of severe autoimmune hemolytic anemia.Patients with hypercoagulable states, thrombotic events and IBD usually require careful administration of anticoagulant agents. Sulfasalazine or azathioprine may reduce the effect of oral coumarin anticoagulants, while heparin is usually effective. Low molecular weight heparin may be used as a chronic regimen if required, balancing the dose at safe levels. (EN)


Αγγλική γλώσσα


Hellenic Society of Gastroenterology (EN)

Annals of Gastroenterology; Volume 15, No 2 (2002) (EN)

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