Purpura due to deep venous thrombosis

Abstract

An 81-year-old woman presented with swelling and purpuric rash on her right leg lasting for 1 month. She reported no fever or dyspnea but complained of right leg pain. She had hypertension and dyslipidemia. On presentation, her vital signs were not significant. On examination, her right lower limb was swollen with a slightly dark-colored skin and nontender, nonpalpable purpura over her right lower leg (Figure 1A). Laboratory tests showed normal platelet counts and elevated D-dimer levels. Subsequent contrast-enhanced computed tomography revealed venous thrombosis from the right femoral vein to the right popliteal vein but no pulmonary embolism. Intravenous heparin improved her limb swelling and purpura within 7 days (Figure 1B). Then, she was discharged after switching from heparin to apixaban.

Purpura is a clinical manifestation of blood extravasation into the mucosa or skin due to vessel wall damage, vascular occlusion, or coagulopathy.¹ Features of purpura in this case suggest a congestion of the anterior accessory great saphenous vein, which drains into the femoral vein.² Given that purpura is an unusual presentation of deep vein thrombosis,^{1, 3} in addition to venous occlusion by thrombosis, locally incompetent valves and a weakened venous wall, particularly in older women,⁴ might cause purpura at the proximal lower limb.

None.

The authors declare that they have no conflicts of interest.

Approval of the research protocol: N/A.

Informed consent: Informed consent was obtained from the patient.

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Animal studies: N/A.