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Prolonged Lower Extremity Symptoms Post-covid-19 In An Adolescent: A Missed Diagnosis - Page #1
 

Author: Harrison Chan, DO
Co Author #1: Samantha Smith, MD
Senior Editor: Kristine Karlson, MD, FAMSSM
Editor: Shayne Fehr, MD

Patient Presentation:
A 22-year-old male former high school athlete presented to the sports medicine clinic in 2025 with chronic exertional right leg swelling, tightness, and discomfort.

History:
The patient reported that his symptoms began in 2020 at age 17, shortly after a confirmed COVID-19 infection. Within two weeks of the viral illness, he developed posterior thigh pain and leg swelling that was initially attributed to a muscular strain during an orthopedic telehealth visit. Lower leg radiographs and magnetic resonance imaging were obtained at that time, which demonstrated diffuse soft tissue edema of the calf. He was referred to physical therapy, but he was unable to schedule sessions due to early pandemic closures and was subsequently lost to follow-up. Over the next four years, he experienced persistent exercise-induced swelling, heaviness, and visible asymmetry of the right lower extremity, which worsened significantly with running and prolonged standing. He had no known personal or family history of hypercoagulable disorders.

Physical Exam:
Vital Signs: T: 37 degrees C; BP: 116/64 mm Hg; HR: 74 bpm
General Appearance: Well-appearing male, not in acute distress.
Musculoskeletal:
Right thigh enlarged compared to the left lower extremity (4.4 cm circumference difference).
Right calf enlarged compared to the left lower extremity (2.5 cm circumference difference).
Mild diffuse posterior thigh tenderness upon palpation, with no focal defect appreciated.
Full range of motion noted at the hip, knee, and ankle joints.
No muscular strength deficits demonstrated.
Skin: Prominent superficial collateral veins present across the right lower extremity; no ecchymosis noted.
Neurovascular:
Sensation intact to light touch bilaterally.
Distal dorsalis pedis and posterior tibial pulses 2+ and symmetric bilaterally.
Normal capillary refill present; the limb was warm and well-perfused.

Click here to continue. Challenge yourself by writing down a broad differential diagnosis before moving to the next slide.

NOTE: For more information, please contact the AMSSM, 4000 W. 114th Street, Suite 100, Leawood, KS 66211 (913) 327-1415.
 

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4000 W. 114th Street, Suite 100
Leawood, KS 66211
Phone: 913.327.1415


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