C0376 Venous thrombosis revealing a multiple myeloma

Background: It is now established well that the intestinal chronic inflammatory disease are associated to a venous significant risk of venous thromboembolism (MTV). Global prevalency of venous thromboembollism during these affections would be about 6% and the risk of venous thromboembolic events would bemultiplied by 3,5. A pulmonary embolism is found in the autopsy in near 40%des death during these affections. The incidence of the MTV seems particularly raise during the first five years following the diagnosis. But it rarely precedes the disease. We report two cases of venous thrombosis revealing a crohn‘s disease Results: Case report 1 : We report the case of a 46-year-old patient , operated 3 months ago for a microlithiasic cholecystitis complicated with an angiocholitis and with cephalic pancreatitis stage B of Balthazar and hospitalized for pain and functional disability of the left lower limb evolving for 4 days. The venous doppler echography of lower limbs showed an aspect in favour of a thrombophlebitis of the left deep and superficial femoral veins as well as the external and primitive iliac homolaterales veins. There were no signs of pulmonary embolism. Risk factors of thromboembolic disease : recent surgery, venous insufficiency and obesity (BMI upper to 30). Physical examination did not found signs in favour of a neoplasy or of a Behcet'disease. The dosage of the tumoral markers was normal. The patient was treated by heparinotherapy and antivitamine K with good evolution. Seven months later, the patient presented proctorrhagia of weak to average abundance with a diarrhea at the rate of 3 saddles / day. Hemodynamic state was correct and there was an overdose in antivitamin K. We thus completed by a colonoscopy showing a fragile congestive mucous membrane strewed with fine ulcerations in sigmoid. Within the pathological mucous membrane, it exists zones of normal mucous membrane with variable-sized going from 1 cm to a 3–4 cms. The rectum was less affected with a normal mucous membrane. The biopsies were in favour of a disease of crohn in push of average intensity. The patient was treated handled by Mesalazine. Case report 2 We report the case of a 30-year-old patient, with past history of recidivant deep venous thrombophlebitis since 1999 (5 episodes of thrombosis in 8 years) and buccal aphtosis. Risk factors of thromboembolic disease : proteine C deficiency, obesity (BMI upper to 36). Physical examination did not found signs in favour of a neoplasy or of a Behcet'disease. A crohn's disease was diagnostsed at colic biopsy in 2002 in front of digestive signs. A subtotal colectomy with ileorectal anastomose was underwent for right colic stenosis. She was treated by purinethol because of intolerance to imurel. Comment: The arisen of venous thrombosis during a crohn's disease is frequent. Sometimes, it can precede or reveal the disease as it is the case of our patients. Numerous arguments of physiopathological order plead for a specific role of the inflammation in the thrombotic complications: numerous studies described, so, during the pushes of MICI a state of hypercoagulability, associated with a certain degree of endothelial dysfunction, of platelet activation and hypofibrinolysis. A systematic search for this medical affection by the practice of a colonoscopy with biopsiy is imperative in case of venous thrombosis especially in the presence of a suggestive digestive symptomatology or in case of negativity of the aetiologic balance assessment.