Above-knee amputation with insidious pulmonary embolism and hypercoagulability secondary to protein C deficiency

Pulmonary embolus can have insidious onset and unusual etiology. This case report of a 35-year-old woman with hyperthyroidism, atrial fibrillation, and an above-knee amputation demonstrates the subtle presentation of pulmonary emboli. On the rehabilitation ward of a tertiary care hospital, the patient developed undulating fever to 39.6C, rapidly worsening peripheral vascular disease, and pulmonary emboli. Eventually, a protein C deficiency was found; institution of appropriate therapy resulted in rapid improvement. This case reminds physiatrists to evaluate thoroughly the cause of pulmonary thrombi. Currently available assays permit rapid elucidation of factor deficiencies in the workup of the hypercoagulable state.