Phlegmasia Cerulea Dolens (PCD) as a Complication of Covi-19: Case Report

Introduction: Phlegmasia Cerulea Dolens (PCD) is a rare condition with high mortality and morbidity risk resulting due to massive deep venous thrombosis (DVT), arterial occlusion and subsequent compartment syndrome[1-2]. These patients are seen to present with a classical triad of severe pain, significant edema and bluish discoloration (cyanosis) of the affected limb[3]. PCD is the only accepted indication for thrombolysis and/or thrombectomy in patients with DVT, especially in those with signs of ischemia or gangrene. Accordingly, catheter – directed thrombolysis or urgent removal of the occluding thrombi using manual techniques (surgical or catheter-directed thrombectomy) should be seriously considered in this population of patients[4]. The management of this rare condition, its early recognition and initiation of prompt empiric treatment to prevent the lethal complications is vital. Treatment options include, anticoagulation, systemic thrombolytics, catheter directed thrombolysis (CDT), pharmacomechanical CDT, surgical and percutaneous thrombectomy[5]. We report a 42-year-old male, post COVID-19 (2 months), presenting with PCD and treated with thrombectomy. Case Report: A 42-year-old male presented to the out-patient department of our tertiary care hospital with complains of swelling and discoloration of his left lower limb (LLL), on/off pain in the limb and cough. The cough was gradual in onset, present for the past 2 months, non-productive and associated with fever initially (not anymore). He also gave history of one episode of hemoptysis in the past 2 days. Two months ago the patient was in his usual health and had symptoms of cough and body aches. He was diagnosed as a case of COVID-19 and supportively managed. After two weeks, he developed Deep Venous Thrombosis (DVT) and was started on anticoagulation. The patient had no history of thrombotic events or thrombolysis. The DVT progressed in the next fortnight and the patient’s LLL swelling worsened. Upon examination, the patient was not sitting comfortably in his bed with a mild cough and left lower extremity pain. Vitally stable. Systemic examination was unremarkable. Lower left limb examination revealed (Figure 1 and 2) grossly edematous limb, gangrenous with necrotic skin patches, purple in color, cold up to the knee, pulses were palpable in the femoral region while doppler signals were very weak below the popliteal artery, weak motor response and intact sensory responses. The right lower limb was