Unilateral extensive purpura resulting from chronic iliofemoral deep venous thrombosis successfully treated by endovascular therapy with iliac vein stenting

Abstract

Unilateral lower leg purpura is rarely reported and has been reported in pigmented purpuric dermatoses, including lichen aureus, Schamberg disease, linear capillaritis, purpura annularis telangiectodes, and a few cases of DVT. [2][3][4][5] presented a 42-year-old Japanese male with left popliteal vein thrombosis having purpuric spots scattered on the left lower leg; however, the purpura were resistant to the treatment of warfarin and topical betamethasone valerate ointment. Freed et al. 5 also reported a 72-year-old male with extensive right femoral DVT had painless, purpuric rash on the right thigh. It was hypothesized that the purpura was due to a combination of acute increased venous pressure from the large proximal DVT on a background of coagulopathy and thrombocytopenia from advanced liver disease; however, the treatment result of the patient was not shown, so it remains unknown as to whether the purpura improved after the treatment. To our knowledge, our case is the first reported case in the English literature of chronic iliofemoral DVT with extensive unilateral purpura that was successfully treated by endovascular therapy with iliac vein stenting. In addition, only our case confirmed that the purpura was resolved after endovascular therapy.In conclusion, unilateral purpura is a rare presenting sign of DVT; however, the present case illustrates that relieving venous pressure in such cases by endovascular therapy might not only treat the symptoms/signs of DVT but improve and cure unilateral purpura as well.