Phlegmasia cerulea dolens and multiple recurrent thrombotic events as the presenting feature of EML4-ALK translocated non-small cell lung cancer

Phlegmasia cerulea dolens (PCD) is a rare presentation of deep vein thrombosis (DVT) which clinically mimicks arterial ischemia and is caused by extensive thrombotic occlusion of the venous outflow of a major vein of an extremity. DVT is a common and potentially life-threatening complication in patients with lung cancer. We report the case of a patient who developed PCD in an upper limb while receiving anticoagulation treatment with low-molecular-weight heparin (LMWH) for recurrent venous thromboembolism (VTE) events at presentation of EML4-ALK translocated metastasic lung adenocarcinoma. Crizotinib therapy was associated not only with response of metastatic lesions but with a dramatic improvement of cancer-associated hypercoagulability. To our knowledge, this is the first case reporting PCD in an ALK-rearranged advanced NSCLC patient.