Popliteal artery thrombosis as a rare complication of paroxysmal nocturnal hemoglobinuria (PNH): A case report

Kiran Bhusal; Prashiddha B Kadel; Khagendra Bhandari; Shova Aryal; Nitin Gyawali; Ashok Kushwaha; Kajan Raj Shrestha; Anjan Shrestha

doi:10.1016/j.ijscr.2021.106445

Popliteal artery thrombosis as a rare complication of paroxysmal nocturnal hemoglobinuria (PNH): A case report

Int J Surg Case Rep. 2021 Oct:87:106445. doi: 10.1016/j.ijscr.2021.106445. Epub 2021 Sep 24.

Authors

Kiran Bhusal¹, Prashiddha B Kadel², Khagendra Bhandari³, Shova Aryal³, Nitin Gyawali³, Ashok Kushwaha³, Kajan Raj Shrestha², Anjan Shrestha⁴

Affiliations

¹ Maharajgunj Medical Campus, Institute of Medicine, Kathmandu, Nepal. Electronic address: kiranbhusal45@gmail.com.
² Manmohan Cardiothoracic Vascular and Transplant Center, Tribhuvan University, Kathmandu, Nepal.
³ Maharajgunj Medical Campus, Institute of Medicine, Kathmandu, Nepal.
⁴ Department of Hemato-Oncology, Tribhuvan University Teaching Hospital, Kathmandu, Nepal.

Abstract

Introduction and importance: Popliteal artery thrombosis a rare but life-threatening complication of Paroxysmal Nocturnal Hemoglobinuria caused due to hemolysis. Complications of further thrombotic event are common after initial management.

Case presentation: A 38 years old male, known case of PNH for 2 years, presented with the history of loss of pain sensation, coldness and loss of movement in left lower leg for 5 days and history of multiple blood transfusion. The patient underwent knee amputation because of possible complication of PNH.

Clinical discussion: Intermittent claudication along with paresthesia, lower extremity weakness, stiffness, and cool extremities are seen in patients of Peripheral Artery Disease. Ultrasound color duplex is a sensitive and specific examination for peripheral flow while gold standard techniques like MRI and CT angiogram to detect and diagnose arterial lesions.

Conclusion: The risk of thrombo-embolism in a patient of PNH should be considered by a treating doctor while early imaging and management should be done to reduce the complications and risk of amputation.

Keywords: Arterial thrombosis; Below knee amputation (BKA); Paroxysmal nocturnal hemoglobinuria (PNH).