A multimodal therapeutic approach to phlegmasia cerulea dolens in a pediatric patient

Abstract

Phlegmasia cerulea dolens is a rare but serious complication of deep venous thrombosis, which can lead to arterial compromise, tissue ischemia, and gangrene. It typically presents in an elderly population often with coexistent malignancy. There have been no reported cases in the ambulatory pediatric population. The authors report a case of a 5-year-old girl who presented with acute, extensive left lower extremity deep venous thrombosis resulting in phlegmasia cerulea dolens. Pharmacologic and mechanical interventions as described in the adult population were utilized. This case demonstrates that an aggressive, multimodal approach to phlegmasia cerulea dolens can be employed in the pediatric population and result in successful limb salvage.

Severe Acute Respiratory Syndrome Coronavirus 2 Infection and Thrombosis: Phlegmasia Cerulea Dolens Presenting with Venous Gangrene in a Child

“…Occurrence of PCD in healthy pediatric patients is rare. 1 , 2 , 3 Potential protective mechanisms cited include a decreased capacity for thrombin generation, increased alpha-2 macroglobulin inhibition of thrombin, and the antithrombotic potential of the vessel wall. 2 Among adult and pediatric patients, malignancy, sepsis, surgery, hypercoagulable state, and vascular injury (indwelling central lines) predispose to PCD.…”

Pediatric Thrombolysis: A Practical Approach

“…Phlegmasia alba/cerulea dolens: extensive venous thrombosis with total occlusion of venous flow, increased compartment pressures and compromise of arterial blood flow ( 37 ).…”