Streptococcal toxic shock syndrome revealed phlegmasia cerulea dolens of the arm

A 46-year-old woman presented with a painful oedema of the left arm (figure) and a 40·3°C temperature for the past 24 h. She also complained of a 10-day-old trivial wound to the left index finger, which occurred while washing the dishes. An ultrasound scan confirmed radial and ulnar superficial vein thrombosis extended to the elbow's crease and that all arteries were patent. Treatment with heparin (500 IU/kg per h) was started. The left arm became cyanotic in 1 h after the ultrasound scan, so the patient was transferred to the operating room for suspicion of fasciitis.