Upper Extremity Phlegmasia Cerulea Dolens with Compartment Syndrome in COVID-19 Sepsis

A 54-year-old female with leukemia presented with COVID-19 and a right upper extremity indwelling PICC line for chemotherapy administration On hospital admission day 9, she developed acute right upper extremity edema and pain Ultrasound demonstrated complete superficial and deep venous thrombosis up to the proximal subclavian vein Her examination was consistent with acute phlegmasia cerulea dolens and compartment syndrome, but respiratory instability prevented transfer and vascular surgery intervention We instead performed bedside fasciotomies and administered therapeutic heparin and the limb was salvaged This case underscores the potential for successful limb salvage in phlegmasia in the setting of COVID-19 by compartment release and therapeutic anticoagulation