To the Editor.—The article by Wise and Todd in the December issue of the Journal (126:766, 1973), describing their experience with lower extremity venous thrombosis, was most interesting.
We recently studied a 12-year-old previously healthy girl with massive left ileofemoral venous thrombosis associated with an elevated cold agglutinin titer and complicated by multiple small pulmonary emboli. Following a "flu-like" illness of one week's duration for which she was treated at home with an antibiotic, the child was admitted to the hospital with a painful swollen left groin. The edema rapidly progressed to involve the entire lower extremity. A venogram showed complete obstruction of the deep venous system. She subsequently developed signs, both clinically (chest pain) and on lung scan, of several small pulmonary emboli.
As mentioned, her illness was associated with a marked elevation of cold agglutinins to 1:2, 048. Careful search was made for underlying collagen disease, malignant neoplasm, etc,