• Jiyoul Yang, Dae-Hwan Bae, Bumhee Yang, Minjung Bak, and Yoon Mi Shin.
• Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju, Republic of Korea.
• Medicine (Baltimore). 2024 Nov 8; 103 (45): e40442e40442.

RationaleThe incidence of venous thromboembolism is increasing, and it is more common in older than in younger patients. Inferior vena cava (IVC) thrombosis is a rare subtype of deep vein thrombosis, and it is associated with a high incidence of arterial and venous thrombosis in patients with systemic lupus erythematosus (SLE). We present the case of a 25-year-old female patient with a large IVC thrombosis caused by SLE that was intractable to thrombolytic therapy.Patient ConcernsA 25-year-old previously healthy female patient presented to the emergency department with a 5-day history of fever.DiagnosesHer computed tomography revealed a large thrombus with an approximate length 25 cm extending from the suprarenal IVC to the right common iliac vein and the left external and internal iliac veins.InterventionsWe decided to perform intravenous thrombolysis (alteplase 65 mg) because of the massive thrombus burden followed by an infusion of intravenous heparin. However, the size of the thrombus did not showed reduction 3 days after treatment. For the next step, the catheter-directed thrombolysis (CDT) was performed; however, no changes were observed.OutcomesShe was diagnosed with SLE, and the large IVC thrombus gradually improved after primary treatment for SLE, including immunosuppressive drugs combined with anticoagulant.LessonsWe found a large IVC thrombus secondary to SLE in a young female patient. In this case, systemic thrombolysis or CDT did not improve the thrombus. The thrombus only improved after immunosuppressive treatment for SLE. Our case highlights the importance of treatment for etiologic disease in an intractable thrombosis developed by provoked cause.Copyright © 2024 the Author(s). Published by Wolters Kluwer Health, Inc.

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