Acquired factor V inhibitor in a case of pediatric venous thrombosis.

BACKGROUND

The development of acquired factor (F)V with inhibitor (AFVwI) is rare, resulting mainly in bleeding complications, although sporadic cases of thrombosis in adults have been reported.

KEY CLINICAL QUESTION: How do you diagnose and manage a pediatric case of acute deep venous thrombosis associated with the concurrent finding of AFVwI?

CLINICAL APPROACH: A 13-year-old female with Crohn's Disease and May-Thurner anatomy developed extensive deep venous thrombosis of the left lower extremity, complicated by the finding of AFVwI, discovered during the evaluation of a prolonged prothrombin time and a low FV activity. Anticoagulation was initiated with low-molecular-weight heparin followed by a direct oral anticoagulant, rivaroxaban, without any complications. AFVwI was undetectable after 5 months with normalization of FV activity.

CONCLUSION

Our case highlights the first pediatric case of thrombosis with a rare finding of AFVwI, successfully managed with anticoagulation therapy with complete resolution.