Cerebral venous thrombosis in inflammatory bowel disease: a case series

Dear Editor: Cerebral venous thrombosis (CVT) is a rare complication of inflammatory bowel disease (IBD) with only few cases reported in the world literature. The precise mechanism involved in thrombogenesis is unclear and the treatment remains controversial. We describe herein four patients with IBD who developed CVT. Case 1 is a 30-year-old woman with an 8-year history of ulcerative colitis (UC). After a remission period of 4 years on salazopyrine treatment, she presented with abdominal pain, diarrhoea and rectal bleeding. Colonoscopy showed severe active pancolitis and she was treated with corticosteroids and azathioprine, to which she clinically responded. Two months later, she complained of subacute global headache and developed generalised tonic–clonic seizures and altered conscious state. On examination, blood pressure was 120/ 70mmHg and there was no fever. The patient was drowsy and had mixed aphasia and right hemiplegia. Brain magnetic resonance imaging (MRI) showed a left lateral sinus venous thrombosis complicated by a parieto-temporal infarction. She was also found to have a vena cava thrombosis which manifested by fever and abdominal pain few days after admission. Complete blood count showed a microcytic anaemia with a haemoglobin level of 9.3 g/dL and a thrombocytosis of 806×10/L. Erythrocyte sedimentation rate (ESR) was 75 mm in first hour and C-reactive protein (CRP) was 50 mg/dL. Anti-β2-glycoprotein I antibodies were present (IgG = 83 IU/mL, IgM = 16 IU/mL, N