Herpes simplex virus infection, massive pulmonary thromboembolism, and right atrial thrombi in a single patient: case report

We report a 32-year-old man with herpes simplex virus encephalitis who developed massive pulmonary thromboembolism with mobile right atrial thrombi during treatment for this condition. It was not safe to use thrombolytic therapy because of the high risk of cerebral bleeding associated with encephalitis. The patient was initially treated at another center, but his condition deteriorated during nadroparin therapy and he was referred to our hospital. Nadroparin was discontinued, and a continuous infusion of unfractionated heparin was administered through a central venous catheter. The patient's general status improved over the next 24 hours, and all thrombi in the right atrium disappeared. There was immediate lysis of the thrombi after the continuous infusion of unfractionated heparin was initiated. We suggest that central-line infusion of this agent is preferable to peripheral infusion in such cases. Further research on the potential thrombolytic effect of heparin is needed.