Painful congestion of the lower limbs and recurrent fever

Abstract

We describe a 45-year-old patient with massive pain and congestion in the lower limbs. In addition, he daily presented fever up to 39.5°C (103.1°F) without any infectious focus for 8 days. A formerly unknown vena cava atresia with severe bilateral deep vein thrombosis and concomitant heterozygous prothrombin (factor II) gene mutation (G20210A) was diagnosed during the hospital stay. Because of the severe clinical findings and hereditary thrombophilia, we recommended a lifelong anticoagulant therapy and elastic stockings. Furthermore, different diagnosis and treatment strategies are discussed in case of concomitant prothrombin gene mutation.