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

Abstract

SUMMARY
Thromboembolic events occur in UC and Crohns 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not be withdrawn or administered at reduced doses in cases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.