Thromboembolic complication of nephrotic syndrome: a case of pulmonary embolism

Pulmonary thromboembolism (PTE) is a frequently encountered, difficult-to-diagnose condition with high mortality. While many risk factors such as lower extremity fractures, myocardial infarction, immobilization, and malignancy are well known, nephrotic syndrome remains a rare secondary risk factor. A 28-year-old male patient, hospitalized with a preliminary diagnosis of nephrotic syndrome, developed sudden-onset chest pain and dyspnea on the second day of admission. Although hemodynamically stable, his chest X-ray revealed increased opacity in the right lower zone, suggestive of pulmonary infarction. Elevated D-dimer levels and right heart dilatation detected by bedside echocardiography supported the suspicion of PTE, prompting the initiation of anticoagulant therapy. Pulmonary CT angiography (CTPA) confirmed acute thrombi in the right pulmonary artery and its branches along with infarct areas. This case highlights the rare coexistence of nephrotic syndrome and acute PTE in a young adult, emphasizing the importance of recognizing radiological signs and the need for awareness regarding prophylactic anticoagulation in such patients.