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Arterial thrombosis complicating respiratory syncytial virus infection

Respiratory syncytial virus (RSV) is the most important respiratory pathogen of early childhood. Here, we present the case of a 3-year-old child with RSV pneumonia who developed brachial artery thrombosis while on treatment. Child was admitted with pneumonia, confirmed as human RSV on real-time polymerase chain reaction panel that showed gradual improvement on symptomatic treatment. However, on day 9 of illness, he developed cyanosis of left upper limb fingers, with cold extremity distal to elbow. Doppler flow showed complete occlusion of the distal part of brachial artery with absent blood flow in the forearm and palm. Intravenous unfractionated heparin was started along with oral aspirin in the anticoagulant dose. It was continued for 48 h with 6 hourly activated partial thromboplastin time monitoring. Child responded well to conservative management after which he was shifted to low molecular weight heparin followed by oral acenocoumarol. After 6 weeks of anticoagulation therapy, now the vessel has almost fully recanalized.