Venous gangrene of lower extremities and Staphylococcus aureus sepsis

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

A 12-year-old girl with severe acute respiratory syndrome coronavirus 2 infection presented as phlegmasia cerulea dolens with venous gangrene. Emergent mechanical thrombectomy was complicated by a massive pulmonary embolism and cardiac arrest, for which extracorporeal cardiopulmonary resuscitation and therapeutic hypothermia were used. Staged ultrasound-assisted catheter-directed thrombolysis was used for treatment of bilateral pulmonary emboli and the extensive lower extremity deep vein thrombosis while the patient received extracorporeal membrane oxygenation support. We highlight the need for heightened suspicion for occult severe acute respiratory syndrome coronavirus 2 infection among children presenting with unusual thrombotic complications.

Phlegmasia Cerulea Dolens in the Pediatric Population: A Life-threatening Condition

BACKGROUND

Phlegmasia cerulea dolens is a rare complication of deep venous thromboembolism that can have life-threatening consequences. It is more commonly reported in the adult population, and rarely in the pediatric population, especially in a healthy child.

CASE REPORT

We report a case of a healthy 7-year-old girl who presented with right leg pain and fever, found to have a thrombus involving her inferior vena cava and right lower extremity. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: This case illustrates the importance of early recognition and a multimodal approach to treatment of phlegmasia cerulea dolens.

Idiopathic unilateral lower limb gangrene in a neonate

We are reporting a very unusual case of unilateral lower limb gangrene in 12 days neonate, who was brought to us with bluish discoloration of left foot with gangrene of toes. A negative sepsis screen, normal Doppler study, normal magnetic resonance angiography and absence of evidence of hypercoagulable state prompted us to make the diagnosis of idiopathic unilateral lower limb gangrene in this newborn. Because of the rarity we are reporting this case with vide review of literature.

Trends in management of phlegmasia cerulea dolens

Phlegmasia cerulea dolens (PCD) is a fulminant condition of acute massive venous thrombosis that may result in major amputation or death unless treated in an early phase. Guidelines for treatment are still not clearly documented. As a consequence, physicians might have limited knowledge of this potential life-threatening condition and its clinical course. Therefore, the purpose of this review was to analyze and summarize clinical manifestations and proposed diagnostic approach, factors that affect the outcome of PCD, and the evolution of management and therapeutic options. Underlying malignancy, pulmonary embolism, and PCD severity are the vital factors that predict the outcome of PCD. In the last decades, treatment options have remained largely unchanged. Published evidence shows that advances in minimally invasive techniques have not yet resulted in outcome improvements compared with traditional surgical thrombectomy. Treatment seems to depend on grading the severity of this condition and experience of the surgeon.

Neonatal frostbite with gangrene of toes

Gangrene of the extremities in the neonatal period is rare. Etiology is not identified in most cases and management is usually conservative. We describe an unusual case of an abandoned neonate with marked hypothermia, who was brought to us with gangrene of toes, during a severe winter. The toes auto-amputated after 2 weeks. A negative sepsis screen, normal Doppler study, and absence of evidence of hypercoagulable state prompted us to incriminate localized cold injury (frostbite) as the probable cause of gangrene in this newborn infant.