Spontaneous deep venous thrombosis in Duchenne muscular dystrophy

Deep venous thrombosis (DVT) is an uncommonly encountered condition in childhood and, as a consequence, the diagnosis may be overlooked. We describe the first two cases of DVT occurring in children with Duchenne muscular dystrophy. Both brothers were wheel-chair-bound for protracted periods. The first case occurred following spinal fusion for scoliosis. The second occurred spontaneously following immobilisation in hospital while undergoing investigation for a ureteric stone. Serological investigations to outrule an underlying thrombogenic cause showed no deficiency of protein C or antithrombin III nor the presence of lupus anticoagulant in either patient. The presence of flaccid lower extremities resulting in prolonged immobilisation combined with an ineffective muscle pump for venous return may have predisposed the patients in our series. The issue of prophylaxis should now be actively considered in such patients in high-risk circumstances.Correspondence to: R. Fitzgerald