Recurrent deep vein thrombosis and pulmonary embolism in a patient with May-Thurner syndrome presenting as low back pain and radiculopathy

Low back pain is among the most common clinical presentations worldwide, with most cases attributed to musculoskeletal or degenerative causes. Vascular pathology, however, is often overlooked in the differential. We describe a patient with chronic spinal disease and May-Thurner syndrome who presented to a pain clinic with acute worsening low back pain radiating bilaterally and new right leg swelling. Clinical suspicion prompted urgent vascular evaluation, revealing acute deep vein thrombosis of the right femoral and popliteal veins and extensive pulmonary emboli. She was treated with anticoagulation and discharged on long-term therapy with haematology follow-up. This case highlights the diagnostic challenge when vascular disease mimics radicular pain and underscores the importance of vigilance in patients with risk factors. Early recognition of venous thromboembolism in atypical presentations is essential to prevent morbidity and mortality.