{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,8]],"date-time":"2026-07-08T10:21:52Z","timestamp":1783506112499,"version":"3.55.0"},"reference-count":13,"publisher":"MDPI AG","issue":"2","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2007,3,1]]},"abstract":"<jats:p>A 42-year-old woman presented to the emergency department with progressive painful discoloration of the digits of her right foot and symptoms previously diagnosed as neuroma. She was admitted to the hospital for dorsalis pedis arterial occlusion and ischemic foot pain. Despite attempts to restore perfusion to the right leg, ischemia of the right foot persisted and progressed to digital gangrene. The patient subsequently required right transmetatarsal amputation and eventually below-the-knee amputation. After extensive inpatient vascular and hematologic work-up of this otherwise healthy woman, test results revealed that she had protein S deficiency, hepatitis C, and human immunodeficiency virus type 1. In addition to describing this patient\u2019s evaluation and treatment, we review protein S deficiency, including its correlation with human immunodeficiency virus type 1 infection and laboratory diagnosis. This case promotes awareness of protein S deficiency and serves as a reminder to the physician treating patients with vascular compromise and a history of human immunodeficiency virus type 1 to include protein S deficiency in the differential diagnosis. (J Am Podiatr Med Assoc 97(2): 151\u2013155, 2007)<\/jats:p>","DOI":"10.7547\/0970151","type":"journal-article","created":{"date-parts":[[2014,4,1]],"date-time":"2014-04-01T10:14:52Z","timestamp":1396347292000},"page":"151-155","source":"Crossref","is-referenced-by-count":4,"title":["Protein S Deficiency and Lower-Extremity Arterial Thrombosis"],"prefix":"10.3390","volume":"97","author":[{"given":"Krista A.","family":"Archer","sequence":"first","affiliation":[{"name":"Department of Podiatric Surgery, St. Barnabas Medical Center, Livingston, NJ. Dr. Lembo is now in private practice, Manahawkin, NJ."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"suffix":"Jr.","given":"Thomas","family":"Lembo","sequence":"first","affiliation":[{"name":"Department of Podiatric Surgery, St. Barnabas Medical Center, Livingston, NJ. Dr. Lembo is now in private practice, Manahawkin, NJ."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jonathan A.","family":"Haber","sequence":"first","affiliation":[{"name":"Department of Podiatric Surgery, St. Barnabas Medical Center, Livingston, NJ. Dr. Lembo is now in private practice, Manahawkin, NJ."}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","reference":[{"key":"2020060316582945000_R1","doi-asserted-by":"crossref","unstructured":"Bick RL: Prothrombin G20210A mutation, antithrombin, heparin cofactor II, protein C, and protein S defects. .Hematol Oncol Clin North Am17::26. ,2003. .","DOI":"10.1016\/S0889-8588(02)00101-6"},{"key":"2020060316582945000_R2","doi-asserted-by":"crossref","unstructured":"Vargel I, Aksu E, Canter HI, et al: Bilateral lower extremity thrombosis in a patient with protein S deficiency. .Ann Plast Surg46::84. ,2001. .","DOI":"10.1097\/00000637-200101000-00021"},{"key":"2020060316582945000_R3","doi-asserted-by":"crossref","unstructured":"Bissuel F, Berruyer M, Causse X, et al: Acquired protein S deficiency: correlation with advanced disease in HIV-1 infected patients. .J Acquir Immune Defic Syndr5::484. ,1992. .","DOI":"10.1097\/00126334-199205000-00009"},{"key":"2020060316582945000_R4","doi-asserted-by":"crossref","unstructured":"Iranzo A, Domingo P, Cadafalch J, et al: Intracranial venous and dural sinus thrombosis due to protein S deficiency in a patient with AIDS. .J Neurol Neurosurg Psychiatry64::688. ,1998. .","DOI":"10.1136\/jnnp.64.5.688"},{"key":"2020060316582945000_R5","doi-asserted-by":"crossref","unstructured":"Lafeuillade A, Sorice M, Griggi T, et al: Role of autoimmunity in protein S deficiency during HIV-1 infection. .Infection22::201. ,1994. .","DOI":"10.1007\/BF01716703"},{"key":"2020060316582945000_R6","doi-asserted-by":"crossref","unstructured":"Lafeuillade A, Alessi MC, Poizot-Martin I, et al: Protein S deficiency and HIV infection. .N Engl J Med324::1220. ,1991. .","DOI":"10.1056\/NEJM199104253241717"},{"key":"2020060316582945000_R7","doi-asserted-by":"crossref","unstructured":"Sorice M, Griggi T, Arcieri P, et al: Protein S and HIV infection: the role of anticardiolipin and anti-protein S antibodies. .Thromb Res73::165. ,1994. .","DOI":"10.1016\/0049-3848(94)90095-7"},{"key":"2020060316582945000_R8","doi-asserted-by":"crossref","unstructured":"Eldrup-Jorgensen J, Flanigan DP, Brace L, et al: Hypercoagulable states and lower limb ischemia in young adults. .J Vasc Surg9::33. ,1989. .","DOI":"10.1016\/0741-5214(89)90054-2"},{"key":"2020060316582945000_R9","doi-asserted-by":"crossref","unstructured":"Horowitz IN, Galvis AG, Gamperts ED: Arterial thrombosis and protein S deficiency. .J Pediatr121::934. ,1992. .","DOI":"10.1016\/S0022-3476(05)80346-4"},{"key":"2020060316582945000_R10","doi-asserted-by":"crossref","unstructured":"Peyton BD, Cutler BS, Steward FM: Spontaneous tibial artery thrombosis associated with varicella pneumonia and free protein S deficiency. .J Vasc Surg27::563. ,1998. .","DOI":"10.1016\/S0741-5214(98)70335-0"},{"key":"2020060316582945000_R11","doi-asserted-by":"crossref","unstructured":"Terzioglu A, Cigsar B, Aslan G: Necrosis of the toe resulting from protein-S deficiency. .Plast Reconstr Surg110::1604. ,2002. .","DOI":"10.1097\/00006534-200211000-00049"},{"key":"2020060316582945000_R12","doi-asserted-by":"crossref","unstructured":"Comp PC, Doray D, Patton D, et al: An abnormal plasma distribution of protein S occurs in functional protein S deficiency. .Blood67::504. ,1986. .","DOI":"10.1182\/blood.V67.2.504.bloodjournal672504"},{"key":"2020060316582945000_R13","doi-asserted-by":"crossref","unstructured":"Wilkerson DK, Burrell L, Cisar LA, et al: Hereditary protein S deficiency in a large New Jersey kindred. .J Vasc Surg18::932. ,1993. .","DOI":"10.1016\/0741-5214(93)90547-Y"}],"container-title":["Journal of the American Podiatric Medical Association"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/meridian.allenpress.com\/japma\/article-pdf\/97\/2\/151\/1418735\/0970151.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"http:\/\/meridian.allenpress.com\/japma\/article-pdf\/97\/2\/151\/1418735\/0970151.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,8]],"date-time":"2026-07-08T10:11:04Z","timestamp":1783505464000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1930-8264\/97\/2\/151"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2007,3,1]]},"references-count":13,"journal-issue":{"issue":"2","published-print":{"date-parts":[[2007,3,1]]}},"URL":"https:\/\/doi.org\/10.7547\/0970151","relation":{},"ISSN":["8750-7315","1930-8264"],"issn-type":[{"value":"8750-7315","type":"print"},{"value":"1930-8264","type":"electronic"}],"subject":[],"published":{"date-parts":[[2007,3,1]]}}}