Catastrophic asparaginase-induced cerebral and systemic thrombosis in a young female with T-cell lymphoblastic lymphoma: A case report & literature review

Asparaginase is a cornerstone in the treatment of acute lymphoblastic leukemia (ALL) and its variant, T-cell lymphoblastic lymphoma (T-LBL), particularly in adolescents and young adults (AYA). However, its use is associated with a significant risk of thrombotic complications due to its profound effects on coagulation pathways. We report a catastrophic case of asparaginase-induced cerebral and systemic thrombosis in a previously healthy 20-year-old female with T-LBL. Despite prophylactic anticoagulation, the patient developed extensive cerebral venous sinus thrombosis, deep vein thrombosis, and pulmonary embolism, necessitating mechanical thrombectomy, Argatroban therapy, and long-term anticoagulation. This case underscores the multifactorial pathophysiology of asparaginase-associated thrombosis and highlights the need for individualized risk assessment, vigilant monitoring, and dynamic anticoagulation strategies. A comprehensive literature review is provided to contextualize the epidemiology, mechanisms, risk factors, prevention, and management of this life-threatening complication, with practical recommendations for optimizing care in high-risk patients.