Endovascular treatment of cerebral venous sinus thrombosis in a thrombocytopenic patient with systemic lupus erythematosus and antiphospholipid syndrome: A CARE-compliant case report.

rationaleThe co-occurrence of extensive cerebral venous sinus thrombosis (CVST) and severe thrombocytopenia is rare even in patients with triple-positive antiphospholipid syndrome (APS) and systemic lupus erythematosus. This case illustrates the complexity of managing a thrombocytopenic patient with CVST and endovascular thrombectomy as a rescue therapy. PATIENT CONCERNS: The patient was a 33-year-old female with newly diagnosed systemic lupus erythematosus and a 2-day history of fever, headache, and dizziness. During admission, right periorbital ecchymosis and thrombocytopenia (14,000/μL) were observed, and the patient was diagnosed with triple-positive APS. The patient complained of new-onset blurred vision, impaired right lateral gaze. Suspecting increased intracranial pressure, brain magnetic resonance imaging (MRI) was performed, which showed venous thrombosis in the right transverse sinus, bilateral sigmoid sinuses, and bilateral internal jugular veins. These findings, combined with the patient's binocular diplopia, suggest an increased intracranial pressure secondary to CVST. DIAGNOSES: The patient was diagnosed with thrombocytopenia secondary to APS complicated by extensive CVST.

interventionsThe patient received intravenous immunoglobulin, methylprednisolone pulse therapy, and rituximab to treat immune thrombocytopenia. She accepted retrograde balloon-assisted venous thrombectomy for CVST. OUTCOMES: During the 1-year follow-up, the patient did not experience a decrease in platelet count or recurrence of thrombosis while being maintained on anticoagulants and immunosuppressants. LESSONS: This case highlights that endovascular thrombectomy (EVT) may be a rescue option for CVST in patients with triple-positive antiphospholipid syndrome and severe thrombocytopenia, once platelet counts are stabilized with immunosuppressive therapy. Prompt correction of thrombocytopenia can create a safe window for intervention, potentially avoiding neurological deterioration when anticoagulation alone is insufficient or is contraindicated.