Acute arterial thrombosis in a patient with nephrotic syndrome and antithrombin deficiency on steroid therapy: A case report and literature review

Acute arterial thrombosis in a lower extremity is an unusual and serious complication in patients with nephrotic syndrome (NS) and coexisting antithrombin deficiency (ATD). Here we report the case of a patient with NS who was on steroid therapy, had a family history of pulmonary embolism, and had ATD that worsened after endovascular treatment of acute arterial disease in a lower extremity and was refractory to anticoagulant therapy. Thrombectomy and catheter-directed thrombolysis were unsuccessful and amputation was required. Vigilance is necessary in patients with refractory NS during steroid therapy, given the risk of thromboembolic complications that may require aggressive management. We believe that effective alternative anticoagulant therapy can promote recovery and improve the prognosis in patients with both NS and ATD.