Concomitant ST-elevation myocardial infarction and deep vein thrombosis in a patient with severe factor XII deficiency: case report and review of the literature.
Since its first discovery in 1955, coagulation factor XII (FXII) deficiency was, quite surprisingly, linked with thrombosis instead of haemorrhage; indeed, John Hageman ultimately died from pulmonary embolism.1 After this, several reports have highlighted the association between both arterial and venous thrombosis and FXII deficiency; however, a causal relationship is still questioned. Here, we report the case of a woman with severe factor Hageman deficiency who was presented with concomitant myocardial infarction and deep vein thrombosis.

An 86-year-old woman presented to the Emergency Department because of sudden onset dyspnoea. After initial evaluation, the presence of bilateral femoral vein thrombosis was noted (Figure 1); a computed tomography scan did not reveal pulmonary embolism and was remarkable for the presence of ground-glass bilateral opacities and suspected secondary lesions of the lungs and liver (Figure 2). Electrocardiogram (Figure 3) and cardiac enzymes were consistent with subacute, ST-elevation myocardial infarction (STEMI), and the patient was admitted to Coronary Care Unit. Blood test results at admission are shown in Table 1. Due to the presence of prolonged activated partial thromboplastin time (aPTT), that was interpreted as caused by liver infiltration and insufficiency, the patient was treated with aspirin only and, on fifth day, transferred to our ward for further evaluation. 



Figure 1. 
Ultrasound and doppler scan of the left femoral vein showing …