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Phlegmasia Cerulea Dolens Secondary to COVID-19 and May-Thurner Syndrome: A Case Report

Lamia Alghamdi1, Nashwan Alattab2, Abdullah Alwohaibi1

  • 1Internal Medicine, King Fahad Medical City, Riyadh, SAU.

Cureus
|February 21, 2022
PubMed

Insights

Coronavirus disease 2019 (COVID-19) increases the risk of deep vein thrombosis, which can rarely lead to phlegmasia cerulea dolens. This case highlights a COVID-19 patient with May-Thurner syndrome and this rare complication.

Area of Science:

  • Vascular Medicine
  • Infectious Diseases
  • Hematology

Background:

  • Coronavirus disease 2019 (COVID-19) is recognized for its association with a heightened risk of thromboembolic events.
  • Deep vein thrombosis (DVT) is a common complication, but its rare progression to phlegmasia cerulea dolens (PCD) presents a critical clinical challenge due to high morbidity and mortality.
  • May-Thurner syndrome (MTS), a condition involving iliac vein compression, can predispose individuals to venous thromboembolism.

Observation:

  • A middle-aged male patient presented with symptoms indicative of phlegmasia cerulea dolens.
  • The patient's presentation occurred in the context of a confirmed Coronavirus disease 2019 infection.
  • Diagnostic workup revealed underlying May-Thurner syndrome and transiently positive antiphospholipid antibodies.

Findings:

  • The case illustrates a rare instance of phlegmasia cerulea dolens developing in a patient with COVID-19.
  • The co-existence of May-Thurner syndrome was identified as a significant predisposing factor for the severe thrombotic event.
  • Transient antiphospholipid antibodies were detected, suggesting a potential contribution to the hypercoagulable state in this COVID-19 patient.

Implications:

  • This case underscores the critical importance of recognizing severe thromboembolic complications, such as PCD, in COVID-19 patients.
  • It highlights the potential interplay between viral infections, anatomical predispositions like MTS, and autoimmune markers in precipitating catastrophic venous events.
  • Clinicians should maintain a high index of suspicion for severe DVT complications in COVID-19, particularly in patients with pre-existing risk factors.

Keywords:
catheter-directed thrombolysiscovid 19deep vein thrombosis (dvt)may-thurner's syndromephlegmasia cerulea dolens

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