Non-thrombotic superficial venous phlebitis secondary to Covid-19 vaccine or subsequent Covid-19 infection

Abstract

A 43-year-old woman presented with localised areas of prominent, tender superficial veins in her right arm and both legs, and chest pain, following the second dose of AstraZeneca vaccine and possible contemporaneous Covid-19 infection. Electrocardiogram, troponin and d-dimer had all been normal. However, a venous duplex ultrasound scan showed a perivenous inflammation without thrombosis in the areas of her limbs with prominent tender veins, but not elsewhere. We suggest that patients may present with prominent and tender superficial veins secondary to non-thrombotic phlebitis following Covid-19 infection or the AstraZeneca vaccine, which appears to be self-limiting. In addition, this case raises the possibility that Covid-19 infection or the AstraZeneca vaccine may directly affect cells in the vein wall, resulting in phlebitis without any evidence of thrombosis or microthrombosis. This phenomenon appears to be transient and self-limiting.

Keywords: Covid-19; non-thrombotic; phlebitis; vaccine; veins.

Figure 1.

Ultrasound showing two superficial veins in the transverse section in the left thigh’s sub-cutaneous fat, with perivenous inflammation (arrows).

Figure 2.

Ultrasound showing a superficial vein in the transverse section in the right calf’s sub-cutaneous fat, with the lateral extent measured on both sides by the calipers.