Cerebral Venous Thrombosis Involving the Vein of Labbé and Left Sigmoid Sinus in a Patient With Immune Thrombocytopenia Treated With Romiplostim: A Case Report and Literature Review

Cerebral venous thrombosis is an uncommon but potentially serious condition primarily affecting young women. Thrombosis of the vein of Labbé is a rare site of thrombosis linked to hemorrhagic venous infarction. Thrombotic events have been reported in patients with chronic primary immune thrombocytopenia (ITP) treated with thrombopoietin receptor agonists (TPO-RAs). A 33-year-old woman with chronic ITP, treated with romiplostim for five years, presented with a progressively worsening occipital headache and a generalized seizure. Computed tomography showed a left parietotemporal intraparenchymal hemorrhage. Magnetic resonance imaging and venography confirmed left sigmoid sinus thrombosis and a hemorrhagic venous infarction caused by thrombosis of the vein of Labbé, along with signs indicating a previous superior sagittal sinus thrombosis. Romiplostim was discontinued after the event, and anticoagulation, along with corticosteroids, was started due to a decline in platelet count. Common causes of cerebral venous thrombosis were investigated and ruled out. The patient was discharged asymptomatic on hospital day 12 and was seen for outpatient follow-up. This case highlights a rare presentation of Labbé vein thrombosis in the setting of long-term use of TPO-RAs and supports a possible association.