Expectant hypercoagulability in chronic disease states, an overlooked diagnosis

A 39-year-old Asian female, is a known case of Ulcerative colitis, Psoriasis and psoriatic arthritis. Five hours later to the cannula removal, she develops a blister, at the site of a cannula inserted for rehydration. A preliminary clinical diagnosis of superficial venous thrombosis was proposed. Ulcerative colitis and Psoriasis have been associated with hypercoagulability; however clinical workup failed to support this etiology; as her INR was 2 and ESR was 14, coagulation studies were within normal range. The noteworthy clinical presentation at cannulation, formation of bullae, or lack of expected hypercoagulability in our patient remains unexplained, since it cannot be attributed to the known risk factors of superficial venous thrombosis, Thrombophlebitis, Hypercoagulability or dermatological lesions instigated by ulcerative colitis, psoriasis, or the side effects of the medications she consumes.