Clotting Without a Clue: A Case Report of Acute Pulmonary Thromboembolism as the Initial Presentation of Focal Segmental Glomerulosclerosis (FSGS)-Associated Nephrotic Syndrome Without Deep Vein Thrombosis

We report the case of a 23-year-old male from rural South India who presented to the emergency department with sudden-onset dyspnea, exacerbated by exertion. He had a recent diagnosis of chronic kidney disease (CKD) and was on irregular outpatient treatment. A CT pulmonary angiogram revealed bilateral pulmonary artery filling defects, consistent with pulmonary embolism (PE). Laboratory workup showed significant proteinuria, dyslipidemia, hypoalbuminemia, and elevated hematocrit. A renal biopsy performed after stabilization confirmed focal segmental glomerulosclerosis (FSGS) with the perihilar variant. The patient was managed with anticoagulation, high-dose steroids, and supportive care. This case highlights the potential for thromboembolic events, such as PE, to serve as the initial manifestation of nephrotic syndrome (NS), even in the absence of deep vein thrombosis (DVT), emphasizing the need for early suspicion and prompt evaluation in young patients with unexplained respiratory symptoms.