Concurrent Chronic Limb Threatening Ischemia and Deep Vein Thrombosis of a Limb in Patient with Systemic Lupus Erythematosus: A Case Report.

Concurrent thrombus formation in both the arterial and venous systems is rare and present as a diagnostic challenge in these cases; therefore, we must explore various possible etiologies and mechanisms. Herein, we report a case of concurrent chronic limb threatening ischemia (CLTI) and deep vein thrombosis (DVT) of a limb in a patient with systemic lupus erythematosus (SLE) and chronic heart failure who underwent laboratory examinations and multimodality imaging. A 37-year-old male presented with a complaint of pain and swelling of the lower left extremity since 21 days before admission. Echocardiography showed dilated all chambers with ejection fraction, moderate-to-severe pericardial effusion, and no intracardiac shunt. Doppler ultrasound of the lower extremities showed DVT at the left mid-femoral and popliteal vein, severe stenosis at the left dorsalis pedis artery, moderate stenosis of the left popliteal, anterior, and posterior tibial arteries, and soft tissue swelling in the tibial region. Computed tomography angiography showed significant stenosis of the left popliteal, anterior, and posterior tibial arteries. The patient was diagnosed with CLTI and DVT of the left inferior extremity, heart failure, SLE, and tuberculous meningitis on antituberculosis medication. Primary amputation was performed, and the patient was discharged uneventfully. Concurrent CLTI and DVT in the same limb caused by SLE and heart failure is a rare condition. In this case, the probable causes were hypercoagulable state and vasculitis. Despite exhaustive attempts, the exact mechanism was not fully elucidated in this patient. However, we excluded other possible causes that require specific intervention, such as intracardiac shunt or phlegmasia cerulea dolens.