Axillary vein thrombosis related to midline catheter in a patient with Wilson’s disease: a case report

Wilson's disease (WD) is a rare hereditary disorder of copper metabolism that requires long-term copper-chelating therapy. In China, cyclic intravenous sodium dimercaptopropanesulfonate (DMPS) is used in hospitalized patients to enhance copper excretion, whereas oral chelating agents are typically used for maintenance therapy. We report a 44-year-old woman with WD complicated by liver cirrhosis and prior splenectomy who developed left axillary vein thrombosis six days after midline catheter placement for intravenous DMPS infusion. Baseline evaluation showed WD-related hepatic and neurological involvement, with normal conventional coagulation parameters but evidence of platelet activation. Duplex ultrasound confirmed axillary vein thrombosis. The patient was treated with oral rivaroxaban for 3 months, resulting in complete symptom resolution. Follow-up ultrasound suggested recanalization of the affected vein, and no recurrence of thrombotic events occurred during 6 months of follow-up. This case highlights a potential risk of catheter-related thrombosis in WD patients with additional prothrombotic factors and underscores the importance of careful venous access management during inpatient intravenous therapy.