METABOLIC SYNDROME AND INHERITED THROMBOPHILIA: ARTERIAL THROMBOSIS MASQUERADING AS ACUTE PANCREATITIS

This case report presents a 38-year-old woman with metabolic syndrome (poorly controlled type 2 diabetes, HbA1c 13.2%; hypertension) and previously undiagnosed thrombophilia who developed extensive arterial thrombosis mimicking acute pancreatitis. The patient presented with a two-month history of intermittent epigastric pain that acutely worsened, accompanied by severe metabolic acidosis (bicarbonate 10.3 mmol/L), marked leukocytosis (35.8 × 10³/μL), and moderately elevated pancreatic enzymes (amylase 223 U/L, lipase 324 U/L). Coagulation studies revealed profoundly elevated D-dimer (5,200 ng/mL) and brinogen (680 mg/dL), with identied deciencies in protein C (35%), protein S (42%), and antithrombin III (55%). Contrast-enhanced computed tomography (CT) demonstrated thrombotic occlusion of the suprarenal aorta and celiac axis without pancreatic necrosis. Management included therapeutic anticoagulation (lowmolecular-weight heparin transitioned to warfarin) and intensive metabolic control. This case highlights three key clinical insights: (1) the diagnostic challenge of differentiating vascular thrombosis from pancreatitis in metabolic syndrome patients, (2) the catastrophic thrombotic potential of combined metabolic and hematologic disorders, and (3) the necessity of multidisciplinary management addressing both acute thrombosis and underlying predispositions. The case underscores the importance of comprehensive thrombophilia evaluation in patients with unexplained arterial thrombosis and metabolic risk factors.