Venous thromboembolism in a woman with diffuse adenomyosis presenting as heavy menstrual bleeding: A case report

Tóm tắt

Background

Pulmonary embolism with concomitant adenomyosis is uncommon. Few case reports have described the interesting combination of venous thromboembolism (VTE) and adenomyosis which poses a challenging management dilemma. Treatment of adenomyosis would aggravate thromboembolism and vice versa. Anticoagulation would predispose the patient to more bleeding, while hormonal or antifibrinolytic therapy for menorrhagia is contraindicated in active VTE.

Methods

This is a case of 41-year-old Filipina, nulligravid with no known comorbidities, admitted due to 1 month history of easy fatigability. Work up revealed acute pulmonary embolism with underlying Protein C deficiency and with concomitant diffuse adenomyosis presenting as abnormal uterine bleeding. The patient was treated with anticoagulation therapy for pulmonary embolism and with GnRH analog for adenomyosis.  She was discharged stable and was advised close follow up for monitoring. 

Results

Few case reports have described the interesting combination of adenomyosis and venous thromboembolism which poses a challenging management dilemma. In this patient with underlying protein C deficiency who presented with pulmonary embolism and deep vein thrombosis, the appropriate management is the use of anticoagulation. However, considering that the patient was also diagnosed of diffuse adenomyosis and concomitant abnormal uterine bleeding, anticoagulation may worsen the patient’s bleeding and anemia. Treatment of adenomyosis using combined oral contraceptive pills would aggravate thromboembolism and vice versa. This patient was managed successfully using a multidisciplinary approach with anticoagulation and GnRH analog injection with no adverse event noted.

Conclusion

In conclusion, occurrence of venous thromboembolism in patients with adenomyosis is uncommon and several treatment dilemmas may be encountered, however it can be managed successfully with careful multidisciplinary planning, timely intervention and meticulous monitoring. Efficient follow-up strategy after pulmonary embolism should be provided together with continuous gynecologic  treatment and monitoring to prevent recurrence and adverse side effects of anticoagulation treatment.