An exceptional presentation of nephrotic syndrome: bilateral massive pulmonary embolism.

Venous thromboembolism (TE) and arterial TE are rare in children, but can cause severe morbidity and mortality. The incidence of TE is 8.6-57 per 100 000 among hospitalized children and 0.14-0.9 per 100 000 in the general pediatric population. The risk of TE is increased in pediatric nephrotic syndrome (NS) patients. The incidence of thromboembolic complications in pediatric NS patients is approximately 3%. Herein we report a pediatric patient that presented with massive bilateral pulmonary embolism (PE) in whom the underlying condition was NS. At the onset of the clinical course the clinical findings were attributed to heart failure and, therefore, the diagnosis and treatment of NS was delayed. Based on the presented case, we think that clinicians should consider NS in pediatric patients with PE when hypoalbuminemia, diffuse edema, and massive proteinuria are present, and that timely initiation of NS treatment and concomitant administration of TE treatment can yield positive results. We further think that pediatric patients diagnosed with PE that have concomitant hypoalbuminemia, generalized edema, and massive proteinuria should be considered to have NS and that treatment for NS should be started without delay and concomitantly with TE treatment in order to achieve a positive result.