Severe outcome in rare upper extremity phlegmasia cerulea dolens

CaseA 53-year-old woman with hypertension and COPD arrived at the emergency department (ED) by EMS after she had developed respiratory distress.She was intubated in route to the hospital and deteriorated into asystole requiring CPR for 20 minutes.Return of spontaneous circulation was achieved in the ED, and the patient was admitted to the medical intensive care unit (MICU) for further management.There was a purpuric discoloration on the patient's right upper arm, extending proximally from the fingers to the dorsum of the right forearm (Figure 1); pulses were palpable.The patient was afebrile, hemodynamically stable, and on mechanical ventilation.Labs revealed a WBC of 29 K/µL, sodium 149 mmol/L, Cr 2.8 mg/dL, elevated liver enzymes, and creatinine kinase 3000 U/L.Lactic acid was 8.8 mmol/L;