BACKGROUND: Nephrotic syndrome, a condition that induces a hypercoagulable state, poses a significant risk of thromboembolism, a potentially life-threatening complication. While venous thromboembolism in nephrotic syndrome typically manifests as pulmonary emboli, deep vein thrombosis, and renal vein thrombosis, mesenteric vein thrombosis is a rare occurrence. The rarity is further accentuated when it occurs in patients with minimal change disease, with only a handful of cases reported in the literature.

CASE PRESENTATION: The patient is a 25-year-old Syrian male, previously in good health, presenting with severe abdominal pain and vomiting that had persisted for 6 days. Investigations revealed hypoalbuminemia with nephrotic range proteinuria. Computed tomography scan of the abdomen and pelvis with contrast showed superior mesenteric vein thrombosis. Renal biopsy revealed minimal change disease. The patient was mainly treated with a therapeutic dose of enoxaparin, followed by apixaban. He also received oral prednisolone, a short course of cyclosporine, and furosemide. With the appropriate treatment, the patient's symptoms gradually improved and he was discharged. This successful management of a rare complication in a nephrotic syndrome patient demonstrates the potential for positive outcomes in such cases.

CONCLUSIONS: This unique case underscores the importance of early recognition and appropriate management of thromboembolic events in nephrotic syndrome. By presenting this case, we aim to alert clinicians to the possibility of mesenteric venous thrombosis, a rare but potentially serious complication. Such reports are crucial in informing more effective clinical decision-making and improving outcomes for nephrotic syndrome patients.