Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0012739 (disseminated intravascular coagulation)
 8,673 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Purpura Fulminans and DIC were the main clinical manifestations of the antiphospholipid syndrome observed in a 62-year-old man. The patient was well until 44 years of age when he began to suffer from recurrent thrombophlebitis, without other symptoms suggestive of immune disease. At the time of hospital admission the pt. appeared acutely ill, showing high fever, severe anemia, massive urinary blood loss, multiple purpuric patches evolving to hemorrhagic bullae and gangrene rapidly spreading over about 30% of the total body area. No signs of neurological involvement or of visceral thrombotic occlusions were present. Clotting tests were consistent with a diagnosis of DIC, further confirmed by skin biopsy showing the presence of thrombi in dermal arterioles. The autoantibody research was positive as follows: Waaler-Rose 1:40, Anti-DNA 1:80; ANF 1:640, aCA IgG 100 GPL. LA was diagnosed according to standard criteria: prolonged KCT and RVVT not corrected by a mixture of normal plasma and abnormal TTI. Plasma exchange in association with heparin and prednisone was effective in arresting the progression of the skin lesion; nevertheless the patient died ten days after hospital admission for sepsi and acute renal failure.
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PMID:Purpura fulminans as clinical manifestation of atypical SLE with antiphospholipid antibodies: a case report. 180 49

Twenty patients with peripheral arteritis due to an infectious disease were studied with the purpose to detect the etiological agent in the vessels belonging to ischemic areas; to establish the relationship between the onset and evolution of the ischemic lesions and the infectious disease; and to verify the appropriateness of the treatment with anticoagulants. Ten patients had meningococal disease with positive blood culture for Neisseria meningitidis. The meningococci were found in vessel walls of ischemic areas. The cutaneous lesions had sudden onset and a rapid evolution. Five patients had pneumonia or gastroenteritis. No microorganisms were detected in the vessel walls of the ischemic areas. The cutaneous necrotic lesions appeared from two to six days after the infectious disease was diagnosed. Therefore, heparinization was considered appropriate to block the extension of the disseminated intravascular coagulation secondary to the vasculitis. Three patients had, probably, post-streptococcal sensibilization arteritis and two post-measles arteritis. No etiological agent was identified in the vessel walls. The necrotic lesions of the extremities appeared from five to 21 days after the clinical course of the infection. The lesions had the complete evolution in a period from one to four days. It was considered appropriate to start the heparinization in the evolutive period of the peripheral lesions in an attempt to reduce the ischemia by the interruption of the intravascular coagulation related to the vasculitis. In heparinized patients in whom the necrotic lesions did not extend completely in the extremities, the evolution to irreversible gangrene and limb loss did not occur.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Arteritis dependent on infective process: the convenience of heparin use]. 184 98

Purpura fulminans is an uncommon catastrophic syndrome that occurs in children, typically one to four weeks after a seemingly benign infectious process. The child usually presents with a high fever, purpuric ecchymosis, hypotension, disseminated intravascular coagulation, and gangrene of the extremities. We have recently treated six children, whose mean age was 22 months; three were male and three were female. Five of the six had a change of mental status upon initial examination. Their mean temperature was 104 degrees F. All six children had purpuric involvement of their extremities; three had involvement of their hands, two had involvement of their faces, and two had involvement of their trunks. All had absent palpable pulses and sluggish capillary refill in the involved hands and feet. Two patients died shortly after admission as a result of severe end-stage sepsis. The platelet counts in these two patients, and the white blood cell counts were markedly depressed. The mean platelet count of the survivors was 370,000 and the mean white blood cell count was 25,000. Lumbar punctures were positive for bacterial meningitis in five patients and viral meningitis in one patient. All patients were treated with intravenous heparin. Of the four survivors, two lost significant tissue and required multiple plastic reconstructive procedures, and two improved on heparin alone with no tissue loss. In addition to systemic support and intravenous antibiotics, the mainstay of treatment is one of immediate heparinization and a continuous heparin drip. Heparin prevents subsequent small vessel thrombosis and limits tissue loss due to ongoing purpura. Conservative management of the purpuric lesions is the treatment of choice until final demarcation occurs.
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PMID:The surgical implications of purpura fulminans. 234 Feb 49

A 20-year-old man presented to the emergency department (ED) with an injured right hand, fever, and a history of dog exposure. This splenectomized individual developed hypotension less than 90 minutes after arriving in the ED with normal vital signs. He later developed overwhelming sepsis, gangrene, disseminated intravascular coagulation (DIC), respiratory insufficiency, retroperitoneal hematoma, and renal insufficiency. Blood cultures grew Capnocytophaga canimorsus sp nov (formerly Dysgonic Fermenter-2). Sepsis, gangrene, and DIC are more likely to occur in asplenic individuals exposed to this organism. Many physicians use prophylactic outpatient penicillin therapy in asplenic or functionally asplenic victims of dog and cat bites. However, a brief admission or stay in an observation unit may be indicated for these high-risk individuals.
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PMID:Precipitous hypotension in the emergency department caused by Capnocytophaga canimorsus sp nov sepsis. 236 53

Fournier's or genito-perineal gangrene of the male genitalia typically spares the testis, urethra and deep penile components. It usually is polymicrobial and synergistic. To our knowledge, this is the first reported case in the literature with severe, deep, full penile thrombosis that caused a severe urethral stenosis and required later surgery. Only Proteus mb. could be isolated and gave rise to a disseminated intravascular coagulation syndrome that has probably accentuated the thrombotic penile phenomenon. The process was secondary to urethral lithiasis.
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PMID:Synchronous caverno-spongious thrombosis and Fournier's gangrene. 238 54

The cases of nine children who survived the acute stage of meningococcal septicemia and secondary disseminated intravascular coagulation were reviewed. All of the children had major orthopaedic problems as a result of the acute disease. Detailed histological studies were performed on specimens of bone and cartilage, obtained when these patients had either acute amputation for gangrene or subsequent revision for a chondro-osseous deformity. In the specimens that were obtained from the children who had acute gangrene, the histological changes included small-vessel thrombi, osteonecrosis, subperiosteal new-bone formation, cortical disruption, cellular disorganization in the physis, and medullary inflammation. These findings were compatible with a combination of inflammation (acute osteomyelitis) and ischemia. In the specimens that were obtained during revision of the amputation, three years or more after the initial infectious or ischemic process, the clinically relevant findings involved the epiphyses and physes. The growth plates showed variable permanent ischemic damage. Bone bridges connecting the epiphysis and metaphysis were observed in various stages of formation, including several early bridges with involvement of only the physis and metaphysis. Endosteal and cortical bone, in contrast, showed complete recovery with no evidence of permanent ischemic damage. We concluded that children who survive meningococcal septicemia are at high risk for complex orthopaedic problems, both acute and chronic. The disseminated intravascular coagulation and focal infections of the acute phase are primarily responsible for the vascular injuries to the growing chondro-osseous tissues. Ischemic changes also selectively involve the physeal circulation, but may take several years to adversely affect longitudinal and transverse growth of bone.
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PMID:Chondro-osseous growth abnormalities after meningococcemia. A clinical and histopathological study. 250 9

In short, bacterial sepsis is associated with a number of peripheral manifestations involving the skin and soft tissues. The pathogenesis of the lesions observed is not fully understood and is almost certainly multifactorial. In ecthyma gangrenosum, the presence of large numbers of gram-negative bacilli in the walls of small blood vessels without a substantial inflammatory response suggests that either the bacteria themselves or bacterial products are responsible for tissue damage. Endotoxin probably plays a prominent role in producing these lesions. That Pseudomonas and Aeromonas species seem to cause ecthyma out of proportion to their prevalence as a cause of bacteremia might suggest that the endotoxin of these organisms has a special predilection for skin and subcutaneous structures. More likely, it indicates that other bacterial substances, such as exotoxins or proteases, are involved. The absence of PMN leukocytes is thought to play a permissive role, allowing unopposed bacterial proliferation. Lesions of symmetric peripheral gangrene characteristically do not have bacteria present. The presence of intravascular fibrin accumulation probably resembles the generalized Shwartzman phenomenon. However, the gangrenous lesions themselves more likely result from systemic hypotension and the resulting hypoperfusion of the tissues than from vessel obstruction. In lesions associated with vigorous inflammatory response, bacterial products may damage tissue either directly or by attracting leukocytes that, in turn, release substances that cause further tissue damage. An etiologic role for endotoxin or the gram-positive bacterial cell wall is likely, since endotoxin is known to produce similar lesions in the localized Shwartzman reaction. Favoring a role for other bacterial substances is the predisposition of V. vulnificus to cause cellulitis or of C. fetus to cause inflammation of the major vessels during sepsis; the mechanisms for these reactions are entirely unknown. It is interesting that in most instances in which peripheral lesions are caused by sepsis, either a large number of bacteria or an intense inflammatory response by PMNs is present, but not both. In both kinds of lesion, the tendency to involve blood vessels by different pathogenetic mechanisms contributes to the evolution of the disease process. In intensely inflamed lesions, veins and arteries can be shown histologically to be occluded. In the absence of inflammation, bacterial invasion of vessel walls or simply the presence of bacterial products adjacent to the vessel may produce spasm. As noted, the pathogenetic significance of thrombosis observed in the lesions of DIC remains unclear.(ABSTRACT TRUNCATED AT 400 WORDS)
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PMID:Cutaneous manifestations of bacterial sepsis. 252 95

With an adjuvant course of plasmapheresis, a combined treatment of severe acute abscesses and gangrene of the lungs brought about a marked short-term clinical response in 48 out of 50 treated patients. The responders had their temperature returned to normal, amount of sputum significantly reduced. They recovered good appetite and gained weight. There was also attenuation of DIC syndrome and endotheliosis, improvement of cellular and humoral immunity. Upon the discharge 35 patients had complete or partial response, 10 patients developed a chronic process. Lethal outcomes reached 10%.
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PMID:[Plasmapheresis in combined treatment of severe forms of abscesses and gangrene of the lungs]. 258 36

Dysgonic fermenter 2 (DF-2) is a slow-growing gram-negative bacillus causing a zoonotic infection that is acquired through dog bites or other contact with dogs. Splenectomized patients and those with alcoholic liver disease are most susceptible to DF-2 infection. The clinical picture can be one of fulminant septicemia and disseminated intravascular coagulation in the splenectomized patient; the presentation is milder in the alcoholic patient. The overall mortality from DF-2 septicemia among the 41 cases reported in the literature is 27%. The organism is sensitive to penicillin, resistant to aminoglycosides, and not easily grown on common media. It appears to be serum-sensitive in tests with normal human serum. Penicillin prophylaxis of dog bite wounds is especially important in high-risk patients. DF-2 infection should be considered when any splenectomized patient develops fulminant septicemia, disseminated intravascular coagulation, and peripheral gangrene. Examination of a gram stain of the peripheral blood or buffy coat is of value in such cases.
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PMID:Dysgonic fermenter 2 septicemia. 331 33

Defiency of protein C has been reported to be associated with recurrent thrombosis and pulmonary embolism, disseminated intravascular coagulation, and coumarin-induced skin necrosis and peripheral gangrene. That all of these serious and eventually lethal complications of protein C deficiency, including embolic myocardial infarction, may occur in the same person is the subject of this case report and description of pathological findings.
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PMID:Recurrent thromboembolism, disseminated intravascular coagulation, and coumarin-induced skin necrosis associated with protein C deficiency. 342 32


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