Repeated Left Upper Abdominal Pain.

A previously healthy 30-year-old man presented with acute left hypochondrial pain, which he had experienced several times over the past few months. He was afebrile, and physical examinations revealed tenderness at the left upper abdomen. Laboratory testing showed slightly elevated D-dimer levels (2.07 μg/mL), and contrast-enhanced computed tomography of the abdomen showed multiple filling defects in the spleen (Picture). Further testing revealed low protein S activity (23.0%; normal range, 63.0-135.0%), which led to a diagnosis of repetitive splenic infarct due to protein S deficiency (PSD). PSD, which is reported to be seen in 1.12% of the Japanese population (1), can increase the risk of arterial infarction as well as venous thrombosis (2). Patients with this disease are usually managed with long-term anticoagulation therapy, given the risk of recurrent thrombosis and major bleeding. We should keep in mind that PSD can cause acute abdominal pain in patients with no other risk factors.

Picture.

The authors state that they have no Conflict of Interest (COI).