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.