CASE REPORT article
Front. Cardiovasc. Med.
Sec. Thrombosis and Haemostasis
Volume 12 - 2025 | doi: 10.3389/fcvm.2025.1650286
This article is part of the Research TopicCase Reports in Thrombosis: 2025View all 11 articles
Multisystem Embolism in Hereditary Protein C Deficiency with Patent Foramen Ovale: A Case Report
Provisionally accepted
- 1Third Affiliated People's Hospital of Fujian University of Traditional Chinese Medicine, Fuzhou, China
- 2Fujian Medical University Union Hospital, Fuzhou, China
- 3The Second Affiliated Hospital of Fujian University of Traditional Chinese Medicine, Fuzhou, China
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Hereditary protein C deficiency (HPCD) is a rare autosomal dominant thrombophilia caused by PROC gene mutations, predisposing patients to venous thrombosis. Patent foramen ovale (PFO) with right-to-left shunt (RLS) may facilitate paradoxical embolism, increasing the risk of stroke and pulmonary embolism. However, the coexistence of HPCD and PFO leading to multisystem embolism has not been previously reported. We report a 29-year-old woman presenting with sudden-onset altered consciousness. The patient had no traditional cerebrovascular risk factors other than oral contraceptive use. Imaging revealed basilar artery occlusion, left pulmonary embolism, and bilateral iliac vein thrombosis. Laboratory testing demonstrated reduced protein C activity, and genetic analysis identified a heterozygous pathogenic PROC variant (c.541T>G, p.Phe181Val). Transcranial Doppler bubble study, transesophageal echocardiography (TEE), and agitated saline contrast echocardiography (ASCE) confirmed a PFO with grade 3 RLS. The patient was diagnosed with HPCD combined with PFO. She underwent emergent mechanical thrombectomy, inferior vena cava (IVC) filter placement, subsequent PFO closure, and lifelong rivaroxaban therapy. At 1-year followup, she exhibited excellent clinical recovery with complete resolution of symptoms and no evidence of recurrent thromboembolic events. This first-reported case highlights the potential synergistic thrombotic risk of coexisting HPCD and PFO. For patients with unexplained multisystem embolism, thorough evaluation of both conditions is essential, and individualized comprehensive treatment strategies are crucial for a good prognosis.
Keywords: hereditary protein C deficiency, patent foramen ovale, right-to-left shunt, Multisystem embolism, Paradoxical embolism
Received: 23 Jun 2025; Accepted: 19 Aug 2025.
Copyright: © 2025 Chen, Guan and Ni. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Lihua Chen, Third Affiliated People's Hospital of Fujian University of Traditional Chinese Medicine, Fuzhou, China
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