Markus U Wagenhäuser1, Neshlian Ertas2, Tolga A Sagban2, Mareike Witte2, Till Hoffman3, Hubert Schelzig2, Alexander Oberhuber2. 1. Department of Vascular and Endovascular Surgery, University Hospital Düsseldorf, Düssedorf, Germany. Electronic address: markus.wagenhaeuser@med.uni-duesseldorf.de. 2. Department of Vascular and Endovascular Surgery, University Hospital Düsseldorf, Düssedorf, Germany. 3. Department of Hemostaseology, University Hospital Düsseldorf, Düssedorf, Germany.
Abstract
BACKGROUND: Disseminated intravascular coagulation (DIC) can frequently be observed in patients with severe inflammatory response. It is still correlated with a poor prognosis. Activation of coagulation activity leads to occlusions of small vessels resulting in various organ failure symptoms. In addition, secondary fibrinolysis leads to an increased risk of bleedings and means a therapeutic dilemma. Here, we present a case of a 61-year-old Caucasian man with a severe case of DIC and its clinical complications. METHODS: We report the case of a man with a severe case of DIC. Data collection was performed retrospectively. RESULTS: We report the case of a 61-year-old Caucasian man with contact to pigeon droppings in his medical history. This was followed by a rhinopharyngitis, an exanthema, and a recurring priapism. Thrombotic occlusions were predominant on admission, and necrosis of the lower legs, the hands, and the genital resulted in amputation. Hypoperfusion of the rectum and the bladder lead to the creation of a descendostoma and an uretrostoma. Anticoagulation was managed by continuous infusion of unfractionated heparin and activated protein C supplementation. Long-term anticoagulation is managed with rivaroxaban. CONCLUSIONS: Cryptococcus soil inhalation may cause severe DIC resulting in extremity amputations; however, effective anticoagulation and activated protein C supplementation might extenuate the progress. As multiple complications might occur, an interdisciplinary cooperation is essential.
BACKGROUND: Disseminated intravascular coagulation (DIC) can frequently be observed in patients with severe inflammatory response. It is still correlated with a poor prognosis. Activation of coagulation activity leads to occlusions of small vessels resulting in various organ failure symptoms. In addition, secondary fibrinolysis leads to an increased risk of bleedings and means a therapeutic dilemma. Here, we present a case of a 61-year-old Caucasian man with a severe case of DIC and its clinical complications. METHODS: We report the case of a man with a severe case of DIC. Data collection was performed retrospectively. RESULTS: We report the case of a 61-year-old Caucasian man with contact to pigeon droppings in his medical history. This was followed by a rhinopharyngitis, an exanthema, and a recurring priapism. Thrombotic occlusions were predominant on admission, and necrosis of the lower legs, the hands, and the genital resulted in amputation. Hypoperfusion of the rectum and the bladder lead to the creation of a descendostoma and an uretrostoma. Anticoagulation was managed by continuous infusion of unfractionated heparin and activated protein C supplementation. Long-term anticoagulation is managed with rivaroxaban. CONCLUSIONS: Cryptococcus soil inhalation may cause severe DIC resulting in extremity amputations; however, effective anticoagulation and activated protein C supplementation might extenuate the progress. As multiple complications might occur, an interdisciplinary cooperation is essential.
Authors: N Oliver; T Luong; A Tchakarov; M Abdelrahim; V E Mulanovich; D P Kontoyiannis; R Jones; P Kebriaei; J Samuels; W Glass; A Abudayyeh Journal: Bone Marrow Transplant Date: 2016-05-09 Impact factor: 5.483