Journal of Clinical and Aesthetic Dermatology

DEC 2017

An evidence-based, peer-reviewed journal for practicing clinicians in the field of dermatology

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49 JCAD JOURNAL OF CLINICAL AND AESTHETIC DERMATOLOGY December 2017 • Volume 10 • Number 12 B R I E F R E P O R T S Superfcial migratory thrombophlebitis (SMT) is a commonly missed sign of malignancy, and rates of misdiagnosing it as cellulitis are estimated to be as high as 28 percent in hospital settings. 1 There is a broad differential for erythematous skin, including cellulitis, but also many clinical mimickers that can be broadly described as pseudocellulitis. Outpatient diagnoses, such as lymphedematous rubor, dependent rubor, psoriasis, stasis dermatitis, stasis panniculitis, and pigmented purpuric eruptions, and SMT, are characteristic forms of pseudocellulitis. 2 These cases are treated differently than cases of cellulitis. Treating pseudocellulitis with antibiotics, as is typical in the case of a cellulitis, could lead to antimicrobial resistance, hospital overuse, and a delay in proper treatment. Dermatologist expertise is often required for identification and proper treatment, 3 as misdiagnosis by nondermatologist physicians is all too common. 1 We report three cases of SMT that were misdiagnosed and admitted for cellulitis after venous duplex scans (VDS) were interpreted as normal. It is important to emphasize that pseudocellulitis can be life-threatening and/ or indicate life threatening disease states and to note the limitations of the VDS. C ASE PRESENTATIONS Case 1. A man in his 50s presented to the emergency department (ED) with fever and a left calf eruption (Figure 1). Although a VDS was "negative," he was found to have A B S T R A C T Trousseau syndrome is a rare phenomenon in cancer patients characterized by superficial migratory thrombophlebitis. In this brief report, the authors describe three recent case presentations of patients without a prior history of cancer who were treated for cellulitis prior to be admitted to the hospital. All three patients were found to have "negative" testing on venous duplex scanning. Communication with the technicians and additional clinical and laboratory evaluations confirmed Trousseau syndrome as well as an underlying hematologic cancer in each patient. Dermatologists should be aware of the diagnostic limitations in the venous duplex scanning , especially when evaluating superficial veins or areas overlying pain, and should recognize the importance of communicating with the technician performing the procedure. KEYWORDS: Trousseau syndrome, superficial migratory thrombophlebitis, phlebitis, duplex, ultrasound, vascular, purpura Pseudocellulitis Need Not be Benign: Three Cases of Superficial Migratory Thrombophlebitis with "Negative" Venous Duplex Ultrasonography by FRANCES TIAN, MD; KATHERINE R. MAZUREK, BA; ROBERT N. MALINAK, BS; STEVEN M. DEAN, DO, FACP, RPVI; and BENJAMIN H. KAFFENBERGER, MD Dr. Tian is with Ohio State University College of Medicine in Columbus, Ohio. Ms. Mazurek is with the University at Buffalo Jacobs School of Medicine and Biomedical Sciences in Buffalo, New York. Mr. Malinak is with Pikeville College of Osteopathic Medicine in Pikeville, Kentucky. Dr. Dean is with the Division of Cardiovascular Medicine at Ohio State University Wexner Medical Center in Columbus, Ohio. Dr. Kaffenberger is with the Division of Dermatology at Ohio State University Wexner Medical Center. J Clin Aesthet Dermatol. 2017;10(12):49–51 FUNDING: No funding was received. DISCLOSURES: The authors have no financial conflicts relevant to the content of this article. CORRESpONDENCE: Benjamin H. Kaffenberger, MD; Email:

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