A painful massive cyanotic edema of the left leg

A 70-year-old woman presented to our Emergency Department because of acute pain and swelling in her left lower limb. She suffered from depressive syndrome and hypertension, and she had a previous history of breast and uterine cancer. She denied fever and trauma. Her medication included olmesartan/hydrochlorothiazide and unspecified antidepressants. Physical examination revealed blood pressure of 90/60 mmHg, heart rate of 78 bpm, peripheral oxygen saturation of 94% in room ambient, and a unilateral edema of the entire left lower limb with bluish skin discoloration, decreased peripheral sensitivity, and weak peripheral pulses. Laboratory findings showed White Blood Cell count (WBC) 5.53x109/L, Hemoglobin (Hb) 12.5 g/dL, Platelet count (PLT) 137,000/µL, International Normalized Ratio (INR) 1.22, glucose 449 mg/dL, creatinine 1.19 mg/dL (nv 0.5-0.96 mg/dL), C-reactive protein 0.26 mg/dL (nv<1.0 mg/dL), D-dimer 28,920 ng/mL (nv<500 ng/mL), fibrinogen 182 mg/dL (nv 200-400 mg/dL).