A Rare Presentation of Arterial Thrombosis after Venous Thrombosis in a Patient with Gastric Cancer

Background: Venous thromboembolism, which comprises deep vein thrombosis and pulmonary embolism and is a significant cause of morbidity and mortality among patients with cancer. The aim of the present study was to report a rare presentation of arterial thrombosis after venous thrombosis in a patient with gastric cancer. Report of the Case: A 45 year-old female patient with locally advanced gastric cancer referred to our clinic. Before initiation of chemotherapy and in clinical examination, right lower leg pitting edema was observed. In color Doppler ultrasonography, deep vein thrombosis was documented, and she was treated with 60 unit /Bid of subcutaneous low-molecular-weight heparin and chemotherapy was continued. After two days despite a decrease of leg edema, pain in her leg increased, the distal part of the leg became cold and a decrease of pulsation was observed. Patient continued her therapy with diagnosis of phlegmasia alba dolens. After 7 days of this arterial thrombotic event that lasted for 48 hours, the life threatening event subsided. Conclusion: We should be aware of the unusual clinical presentations of deep vein thrombosis as in this case with background of gastric cancer. The rare event of phlegmasia alba dolens occurs only in 1 % of venous thrombosis events and with close observation, correct diagnosis and on time treatment we can prevent the need for amputation. Keywords: Deep vein thrombosis, phlegmasia alba dolens, venous thromboembolism.