Protein S Deficiency: A Case Report

Abstract

Protein S is a glycoprotein created by the body that aids in the prevention of a hypercoagulable state. Protein S-deficient patients are placed on anticoagulant regimens, as there is no current definitive cure. Failure to bring balance to the hematological system in these patients will lead to complications such as widespread clot formation and pulmonary embolisms. Here, we present a 74-year-old female who was admitted to the ICU after collapsing. She presented with respiratory failure, urinary tract infection (UTI), and pneumonia. Magnetic resonance imaging (MRI) scans depicted a thrombus in the distal right transverse sinus and sigmoid sinus. Her hematologic workup showed normal levels of homocysteine, fibrinogen, and protein C levels but protein S levels were reduced to 24%. This case displays the intricate presentation of a rare hematological disease as well as the importance of routine follow-up to maintain patient health.

Keywords: anti-coagulation; bleeding risk; hematological; hypercoagulable state; routine screening.

Figure 1. MRI showing cerebral infarction in the right temporal lobe (red arrow)

Figure 2. MRV showing absent flow in the distal right transverse and sigmoid sinus (red arrow) in comparison to the left (blue arrow)

MRV: magnetic resonance venography