A young woman with severe renovascular hypertension due to essential thrombocytosis: case report and literature review.

Abstract

Essential thrombocytosis is characterized by the presence of microvascular and/or thrombo-hemorrhagic complications. The heart, brain, and peripheral vasculature are the most common sites for arterial thrombosis. Renal artery thrombosis (RAT) is uncommon in essential thrombocytosis patients. We report the case of a 27-year-old primigravida, who presented with accelerated hypertension during her early pregnancy. Despite four antihypertensive medications, her blood pressure (BP) remained uncontrolled. Radiological imaging revealed a left RAT. The presence of thrombocytosis prompted evaluation for essential thrombocytosis, which was confirmed after JAK2V617F positivity and corroborative bone marrow biopsy findings. The patient was deemed ineligible for renal angioplasty. Treatment with hydroxyurea and twice-daily aspirin resulted in BP control. A review of 13 cases of essential thrombocytosis with RAT was also presented. Essential thrombocytosis should be considered in the differential diagnosis of renovascular hypertension in young (< 40 years) women in the presence of thrombocytosis, and a history of prior/concurrent thrombosis or microvascular symptoms.