2. CASE PRESENTATION
A 50-year-old woman presented at our outpatient clinic with acute pain
in her right lower limb after long-distance travel. She complained of a
significant exacerbation of the pain over the past 10 hours, despite the
administration of oral diclofenac sodium. Given the potential diagnosis
of DVT, the patient was subjected to D-dimer and lower extremity venous
ultrasound examinations. As expected, her D-dimer and fibrin degradation
product (FDP) levels were found to be markedly elevated at 6.19 μg/mL
(normal <0.5 μg/mL) and 25 μg/mL (normal <5.0
μg/mL), respectively. The ultrasound examination revealed the presence
of intermuscular vein thrombosis in her calf of the right lower limb
(Figure 1A). She was admitted to our hospital and initiated
anticoagulation therapy using heparin in combination with Panax
notoginseng saponins, a traditional Chinese medicine known for its
anti-inflammatory, antioxidant, and cardiovascular protective effects.
The patient presented with stable vital signs on admission, including a
blood pressure of 120/80 mmHg, heart rate of 80/min, respiratory rate of
20/min, and a temperature of 36.2°C. She reported no chest pain, chest
tightness, or dyspnea. A chest computed tomography (CT) scan was
unremarkable. She married at an adult age (G1, P1), and her husband and
child were in good health. She was on the third day of her menstrual
cycle. She had no history of hypertension, diabetes mellitus,
cardiovascular disease, or venous thromboembolism. She also denied any
family history of these conditions. The patient had previously been
diagnosed with adenomyosis 18 months ago and had undergone three months
of gonadotropin-releasing hormone
agonist (GnRHa) therapy. Laboratory tests revealed significantly
elevated levels of carbohydrate antigen 125 (CA125) at 687 U/mL (normal
range < 35 U/mL) and carbohydrate antigen 199 (CA199) at 64.5
U/mL (normal range < 35 U/mL), along with a slight reduction
in hemoglobin concentration (111 g/L, normal range: 115-150 g/L). There
were no significant findings for coagulation function, platelet count,
biochemistry panel, autoantibodies, antiphospholipid antibodies, or
lupus anticoagulant tests. Given the elevated tumor biomarker levels, an
abdominal CT scan and gynecologic ultrasound were performed to rule out
malignancy. No space-occupying lesions were detected, but a
significantly enlarged uterine corpus (Figure 1B) confirmed adenomyosis
via ultrasonography (Figure 1C).
After a 7-day course of heparin anticoagulation therapy, the patient
experienced complete resolution of lower limb pain and a reduction in
D-dimer levels to 0.87 μg/mL. However, her CA125 level remained high at
401.8 U/mL (Figure 2). Since she did not report any discomfort, she was
discharged from our hospital with a prescription for oral rivaroxaban. A
6-month telephone follow-up was conducted to monitor her prognosis. In
the second month post-discharge, the patient underwent a hysterectomy
procedure at a specialized hospital for adenomyosis treatment. One month
after the procedure, repeat tests for CA125, CA199, and D-dimer revealed
values within the normal range. No thrombus recurrence was observed
during the 6-month follow-up period. The patient signed an informed
consent form for publication on December 20, 2023.