Severe endometriosis complicated by deep vein thrombosis and pulmonary embolism in the absence of hormone therapy: A case report and literature review

OBJECTIVE: To report a rare case of severe endometriosis complicated by deep vein thrombosis (DVT) and pulmonary embolism (PE) without hormone exposure, and review similar cases in the literature. CASE REPORT: A 44-year-old woman with severe endometriosis adenomyosis without hormone therapy history, presented with menorrhagia, dysmenorrhea, and an extremely high serum cancer antigen (CA)-125 level (1065.2 U/mL). Prior to scheduled surgery, she developed mild swelling over her left leg and was found to have extensive DVT over left common femoral to popliteal veins and bilateral multi-focal PE. After anticoagulation therapy and inferior vena cava filter placement, she underwent laparotomic total hysterectomy, bilateral salpingectomy, and ovarian tumor excision. Pathology confirmed endometriosis without malignancy. Postoperative follow-up revealed a normalized CA-125 level and resolution of thromboembolism. CONCLUSION: This case emphasizes the importance of considering thrombotic complications in endometriosis patients with an extremely high CA-125 level, even without hormone exposure or vascular compression.