Deep Vein Thrombosis and Phlegmasia Cerulea Dolens of the Lower Limbs: An Unusual Presentation and an Unknown Etiology
John Omotola Ogunkoya *
Department of Medicine, Benjamin Carson Senior College of Health and Medical Sciences, Babcock University, Ilishan-Remo, Ogun State, Nigeria and Division of Respiratory Medicine and Allergy, Babcock University Teaching Hospital, Ilishan-Remo, Ogun State, Nigeria.
Adesola Temitope Oyelese
Department of Hematology, Benjamin Carson Senior College of Health and Medical Sciences, Babcock University, Ilishan-Remo, Ogun State, Nigeria.
Taiwo Olufemi Solaja
Histopathology Department, Benjamin Carson Senior College of Health and Medical Sciences, Babcock University, Ilishan-Remo, Ogun State, Nigeria.
Abiola Makanjuola
Dermatology Unit, Department of Medicine, Babcock University Teaching Hospital, Ilishan-Remo, Ogun State, Nigeria.
Nta Opeoluwa Boco
Division of Respiratory Medicine and Allergy, Babcock University Teaching Hospital, Ilishan-Remo, Ogun State, Nigeria.
Akinwale Folarin Ogunlade
Division of Respiratory Medicine and Allergy, Babcock University Teaching Hospital, Ilishan-Remo, Ogun State, Nigeria.
Sixtus Chinedu Ekenyem
Division of Respiratory Medicine and Allergy, Babcock University Teaching Hospital, Ilishan-Remo, Ogun State, Nigeria.
*Author to whom correspondence should be addressed.
Abstract
Deep vein thrombosis is the most frequent Venous thromboembolic event seen among individuals with hematological diseases which is associated with high morbidity and mortality. It is associated with various risk factors. It mainly affects the deep veins of the lower extremities and the pelvis. Phlegmasia dolens is an uncommon skin condition associated with or caused by acute deep vein thrombosis and presents in three clinical subtypes such as phlegmasia alba dolens, phlegmasia cerulea dolens, and venous gangrene.
We report a 29-year-old obese female patient who was admitted via the accident and emergency section of the hospital with a history of sudden onset of pain in both lower limbs, colicky abdominal pain, 4 episodes of passage of loose stool, and 8 episodes of non-projectile, non-bilious vomiting. Compressive ultrasonography revealed evidence of occlusion of both external iliac veins and the biopsy of the skin showed the presence of neutrophilic vesicles in the epidermis suggestive of phlegmasia cerulea dolens.
In conclusion, phlegmasia cerulea dolens is a rare clinical skin condition that must be kept in mind by clinicians, especially in patients with a history suggestive of venous thrombosis.
Keywords: Anticoagulant therapy, phlegmasia alba dolens, phlegmasia cerulea dolens, deep vein thrombosis