Deep Vein Thrombosis and Phlegmasia Cerulea Dolens of the Lower Limbs: An Unusual Presentation and an Unknown Etiology

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.