At her hospital follow-up visit, the patient complained of left lower extremity pain and swelling. Labs showed inflammatory markers had again normalized. A lower extremity venous ultrasound was performed immediately and revealed two distal deep vein thromboses (DVT) in the popliteal and gastrocnemius veins.
We decided to treat the distal DVTs with supportive care and close follow-up given the patient was at high risk for falling and anticoagulation was felt to be unacceptably dangerous.
At that time, the patient and her family agreed to treatment with tocilizumab in an attempt to help further wean her prednisone dose. She received 480 mg IV tocilizumab (8 mg/kg) with plans for monthly dosing.