Iron wire phlebitis – a disease of underestimated significance. COVID-19 as a factor increasing the risk of Mondor's disease

Abstract

Mondor's Disease, also known as iron wire phlebitis, is a rare and self-limiting superficial
vein thrombophlebitis that presents with a palpable cord-like induration beneath the skin. Others
symptoms include: pain, swelling and redness of the affected area. It typically affects the vessels of
the chest wall, less frequently the vessels of the penis or the upper limbs. The etiology of the disease
is not fully understood, but it is known that it may be caused by local injuries or surgeries, and it
may accompany cancer or infections. The diagnosis is based in most cases on an anamnesis and
physical examination, confirmed by ultrasound. There are approximately 500 cases of this disease
described in the literature. Iron wire phlebitis is a disease of underappreciated importance, raising
awareness of this condition can facilitate the MD’ diagnosis and reduce unnecessary diagnostic
procedures.
A 36-year-old female patient detects a lump during breast self-examination. The lesion was
located in the upper outer quadrant of the right breast. The ultrasound revealed dilated venous
vessel with thrombosis, which led to diagnose Mondor's Disease. In this case the cause of increased
coagulation may be ablation or COVID-19 infection. It is necessary to find the etiological factors
predisposing to the disease, and extending the diagnosis to exclude other rheumatological,
hematological and neoplastic diseases. The patient received low-molecular-weight heparin, heparin
ointment, painkillers and anti-inflammatory drugs. After one week treatment, the change wasn’t
palpable. Then, instead of LMWH, oral sulodexide was used for treatment.
Thanks to awareness of this disease, it was possible to made an appropriate, quickly
diagnosis and implement treatment, as well as reduce unnecessary medical procedures. The early
diagnosis of MD can help to identify serious causes (for example breast cancer) at an early stage
which will allow to treatment previously undetected changes.