Femoropopliteal deep vein thrombosis as a sentinel finding of probable renal neoplasia in a man with recent chikungunya infection: a case report
DOI:
https://doi.org/10.5281/zenodo.21896657Keywords:
deep vein thrombosis, kidney neoplasms, chikungunya virus infections, anticoagulants, Trousseau syndrome, case reportAbstract
Introduction: Deep vein thrombosis is a frequent manifestation of venous thromboembolic disease, of multifactorial etiology, in which occult neoplasia and recent viral infections are recognized but often underestimated risk factors at initial evaluation.
Objective: To describe a case of femoropopliteal deep vein thrombosis in a man with recent chikungunya infection in whom protocolized evaluation of secondary causes revealed a renal image suggestive of neoplasia.
Case presentation: We present the case of a 69-year-old man with progressive edema and color change of the right lower limb over 11 days, with insidious pain and acute worsening in the last 24 hours, and a history of chikungunya infection 4 months earlier with persistent arthralgia. Venous Doppler ultrasound confirmed thrombosis involving the common femoral, superficial femoral and deep femoral veins and the saphenofemoral junction, with a patent popliteal vein. Laboratory studies showed normocytic normochromic anemia and markedly elevated D-dimer. Anticoagulation was started with low-molecular-weight heparin, later replaced by rivaroxaban. Abdominal computed tomography, requested as part of the secondary-cause workup for deep vein thrombosis, showed an infiltrative hypodense image occupying the left renal fossa with parenchymal destruction, a finding suggestive of renal neoplasia. The patient was referred to a higher-complexity oncology center for further diagnostic workup and treatment.
Conclusions: This case illustrates the value of protocolized evaluation of secondary causes in unprovoked deep vein thrombosis or when risk factors are insufficient to fully explain it, and reinforces venous thrombosis as a possible sentinel manifestation of occult neoplasia.
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