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)

A 30-year-old woman who had until recently been healthy, was transferred to our hospital by ambulance with complaints of dyspnea and pain in both lower limbs. She had 1-week history of sore throat, fever and cough. She had been to a neighboring clinic three days previously, and had been prescribed some medication for bronchitis, but her symptoms had not improved. By the time of admission, she was already in shock and had severe respiratory failure. Laboratory data showed renal dysfunction, disseminated intravascular coagulation, CPK elevation and severe metabolic acidosis. Chest x-ray and CT films revealed consolidation of the entire right lung field. The patient was quickly intubated and we began mechanical ventilation. We immediately initiated broad-spectrum antibiotics, immunogloblin, dopamine hydrochloride and gabexate mesilate, but she died 7 hours later. From cultures of blood and sputum taken from the patient, Streptococcus pyogenes was isolated. On the basis of these clinical and bacteriological findings, we confirmed a diagnosis of pneumonia and toxic shock syndrome caused by Streptococcus pyogenes (STSS). Serologically her M protein was serotyped as M1, and with regard to Streptococcal pyrogenic exotoxin genes were identified as speA and speB. These serological findings were consistent with the most frequent type that causes STSS. In spite of the uncommon cause of community-acquired pneumonia, Streptococcus pyogenes can potentially affect healthy individuals. The pneumonia can be complicated with STSS and so the clinical course may be severe and fulminant. The evidence acquired from this case suggests that in the event of severe pneumonia with shock, we should be aware that this may represent the presence of Streptococcus pyogenes and/or toxic shock syndrome.
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PMID:[Case of severe streptococcus pyogenes pneumonia with streptococcus toxic shock syndrome]. 1859 96

Acute respiratory distress syndrome (ARDS) is a severe lung disease characterized by inflammation of the lung parenchyma leading to impaired gas exchange. This condition is often lethal, usually requiring mechanical ventilation and admission to an intensive care unit. We present two fatal cases of hidden pneumonia in young people and discuss the pathophysiological mechanism of ARDS with reference to the histological pattern. A complete forensic approach by means of autopsy and histological, immunohistochemical, and microbiological, examination was carried out. In both cases the cause of death was cardio-respiratory failure following an acute bilateral pneumonia with diffuse alveolar damage and ARDS associated with sepsis and disseminated intravascular coagulation. Our cases suggest on one side the importance of an early diagnosis to avoid unexpected death while on the other that the diagnosis of ARDS has to be confirmed on the basis of a careful postmortem examination and a complete microscopy and microbiological study.
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PMID:Two fatal cases of hidden pneumonia in young people. 2045 82

A 46-year-old woman was admitted to our hospital because of pain in the right upper quadrant and dyspnea. Abdominal and chest computed tomography (CT) scans revealed areas of low attenuation in both hepatic lobes, left pleural effusion, and multiple nodules in both lungs. Laboratory data indicated disseminated intravascular coagulation. She developed rapidly progressive respiratory and hepatic failure despite intensive treatment including mechanical ventilation and died of respiratory failure 3 weeks after admission. Immunohistochemical analysis of liver necropsy and cytology of the left plural effusion stained positive for factor VIII-related antigen and CD31. Based on these observations, a diagnosis of hemangioendothelioma (EHE), a rare vascular tumor, was made. A rapid clinical course and fatal outcome, as in the present case, are rare clinical manifestations in EHE.
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PMID:Malignant hepatic epithelioid hemangioendothelioma with rapid progression and fatal outcome. 2055 33

Amyopathic dermatomyositis (ADM) is a variant of dermatomyositis that is characterized by the typical skin rash but without the muscle abnormalities. We report a case of ADM complicated with interstitial pneumonitis (IP) and lung cancer. A 73-year-old female was hospitalized for skin rash and dry cough. Skin biopsy findings were compatible with dermatomyositis though no subjective and objective findings suggestive of skeletal muscle involvement were noted. Chest computed tomography (CT) revealed a consolidation of her right upper lung and irregular opacity of bilateral lower lobe. By histopathological evaluation, she was diagnosed as lung cancer with ADM. Therapy consisting of prednisone was begun. Two weeks after the surgery, dry cough progressed. Her acute exacerbation of IP did not respond to the therapy and passed away by disseminated intravascular coagulation and respiratory failure.
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PMID:[Post-operative acute exacerbation of interstitial pneumonea associated with amyopathic dermatomyositis]. 2066 33

Systemic lupus erythematosus (SLE) is a chronic inflammatory disease that can lead to damage to several vital organs. Antiphospholipid syndrome (APS), manifesting as vascular thromboembolic events and morbidities of pregnancy in the presence of antiphospholipid antibodies (aPL), has been described in patients with SLE. Catastrophic antiphospholipid syndrome (CAPS), in contradistinction to APS, is defined as three or more organs affected by thrombotic microangiopathy in patients demonstrating aPL and can result in mortality up to 50%. We describe a unique SLE patient who was diagnosed with recurrent APS presented with axillary venous thrombosis and subsequent superficial edema and compartment syndrome. The CAPS followed and revealed thromboses over liver, spleen, and acute pancreatitis. The spontaneous hemorrhage of left fourth intercostal artery (ICA) and left axillary artery occured at the same time without vasculitis or severe trauma. Though emergency transcatheter arterial embolization (TAE) of the left fourth ICA was successfully accomplished by the radiologist. The repeated computed tomography angiogram of chest demonstrated remission of ruptured ICA. Nevertheless, the patient died of diffuse alveolar hemorrhage and respiratory failure and shock. Both disseminated intravascular coagulation (DIC) and CAPS share similar characteristics encompassing thrombotic microangiopathy, bleeding, thromboembolism, and multiple organ dysfunction. It is difficult to distinguish between them, especially in cases such as our uremic SLE patient with a calamitous disease progression. The emphasis of treatment for DIC is on platelet and fresh plasma transfusion, in contrast with anti-coagulant for CAPS. To the best of our knowledge, this is the first report describing ICA hemorrhage in an SLE patient without vasculitis or aneurysm. The lupus flare initiated a pathological immunological cascade and resulted in the CAPS and the vascular damage.
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PMID:A spontaneous intercostal artery hemorrhage in systemic lupus erythematosus. 2133 30

Acute liver failure is a very complex type of disease with a mortality of up to 90%, leading to numerous severe disturbances of the whole organism. Bleeding because of absent synthesis of various coagulation factors and disseminated intravascular coagulation, acute kidney failure, circulatory failure with vasopressor dependence, respiratory failure with adult respiratory distress syndrome, neurological failure up to coma because of hepatic encephalopathy, and a very high risk of infection and sepsis frequently result from the initial state of isolated liver failure. High urgency liver transplantation is a highly efficient therapy if performed in time. However, increasing the rate of spontaneous recovery of the patients' own liver, and reducing the need for liver transplantation is preferable and would further improve the outcome of acute liver failure. Extracorporeal liver support by multipass albumin dialysis or plasmapheresis and filtering systems may offer a possibility to fulfill these aims of therapy. A prospective study in 88 patients with acute liver failure has shown a nonsignificant trend in improvement of survival after acute liver failure by multipass albumin dialysis and filtering. Other retrospective studies have shown benefits in improving hepatic encephalopathy and brain oedema. Further, an increase in the rate of spontaneous recovery of liver function has been described. With regional citrate anticoagulation for multipass albumin dialysis and filtering, the need for systemic anticoagulation - a potentially very harmful measure in these patients - can be eliminated and the rate of filter clotting can extremely effectively be reduced.
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PMID:Extracorporeal liver support with multipass albumin dialysis or plasmapheresis and filtering systems in acute liver failure. 2182 78

Nocardia is a rare pathogen of peritoneal dialysis-related peritonitis despite its universal presence in soil, organic matter, and water. Human infections are seen mostly in immunocompromized hosts. The usual primary site of lesions is lung. Nocardia can enter the peritoneal cavity through the Tenckhoff catheter. We describe the first case of nocardia peritonitis that had associated nocardia pneumonia. The Tenckhoff catheter was removed due to nonresolution of peritonitis. The organism was resistant to sulfamethoxazole-trimethoprim. The patient developed hypotension, disseminated intravascular coagulation, and respiratory failure and died.
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PMID:Nocardia asteroides peritonitis in peritoneal dialysis patients: Case report and review of the literature. 2202 90

Methicillin-resistant Staphylococcus aureus (MRSA) has become a leading cause of infections in hospitals, and mortality from MRSA bacteremia is high. In this study, we assessed the clinical characteristics and optimum management of 115 patients with MRSA bacteremia who were admitted to Osaka University Hospital between January 2006 and December 2010. Sixty-nine of the patients survived and 46 died of heart failure or renal failure. The nonsurvivors had reduced levels of platelets and albumin, and increased aspartate aminotransferase, total bilirubin, blood urea nitrogen, and creatinine levels. Other causes of death included sepsis, septic shock plus respiratory failure, disseminated intravascular coagulation, and unknown causes. However, a significant number of those whose infections were catheter-derived survived. Nonsurvivors were more often administered catecholamines and consultation with an infection-control team (ICT) was significantly associated with improved survival. Patients about whom the ICT were consulted were administered significantly more additional anti-MRSA drugs, for example trimethoprim-sulfamethoxazole, clindamycin, and gentamycin, than patients who were not the subject of consultation, although trough values for vancomycin did not differ between the two groups. Catheter removal was significantly higher for surviving patients with severe or complicated infections. These results suggest the status of patients with MRSA bacteremia who did not survive was worse than those who did survive, but that ICT consultation might significantly affect survival by recommendation of appropriate care and anti-MRSA drug use.
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PMID:Methicillin-resistant Staphylococcus aureus bacteremia at a university hospital in Japan. 2257 50

During the past 50 years, there have been huge changes in the approach to coagulopathic bleeding following the treatment of traumatic hemorrhagic shock (HS). Treatment during the 1960s consisted primarily of physiologic saline (balanced electrolyte solution [BES]) and whole blood supported with sodium bicarbonate for acidosis. Subsequent coagulopathy was assumed to be caused by lack of the labile factors (FV and FVIII) which were then replaced by fresh whole blood. The decade of 1970s saw the implementation of component therapy by the American Blood Banking Association so that HS was treated with BES and packed red blood cells (RBC). A new paradigm had to be learned to determine when and how much fresh frozen plasma (FFP) was needed to restore all coagulation factors. By the end of 1970s, most trauma centers were supplementing BES and RBC with FFP in patients with severe injuries requiring massive transfusion of more than one circulating blood volume. By the 1980s, the use of FFP skyrocketed, creating a crisis for the American Blood Banking Association. This led to a National Institute of Health Consensus Development Conference which concluded that FFP should be given to only those patients who had a documented coagulopathy as evidenced by a prolongation of the prothrombin time and the partial thromboplastin time. Restriction of FFP replacement to patients with proven coagulopathy after treatment for HS led to postoperative bleeding which was sometimes fatal. During the 1990s, uncontrolled clinical studies and rigorously controlled animal studies showed that FFP should be administered before the onset of proven coagulopathy with prolongation of the prothrombin time and partial thromboplastin time. Later during the 1990s, recombinant-activated factor VII (FVIIa) was purported to provide quicker hemostasis in patients treated with HS. The efficacy of FVIIa supplementation is still being assessed. During the 2010s, the military surgeons promoted the use of a hemostatic regimen which consists of platelets, RBC, and FFP in a 1:1:1 ratio. This recommendation is still being assessed with different authors reporting benefits and detriments. Throughout these years, an unusual entity of disseminated intravascular coagulation (DIC) was known to complicate the resuscitation of seriously injured patients with HS. This syndrome was typically seen after treatment of HS and was associated with abnormal bleeding plus respiratory failure and renal failure thought to be caused by a combination of micro- and macrothromboses. The early studies suggested that the best therapy for breaking this viscous cycle of bleeding and intravascular coagulation was by infusing fresh whole blood. The theoretical benefits of administering heparin to prevent the thrombosis and epsilon-aminocaproic acid to enhance lysis have not proven beneficial. DIC is also seen in association with toxic exposures, including snake bites. Epsilon-aminocaproic acid may be beneficial in that setting. Many of the intricate understandings of DIC remain elusive and are still being studied.
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PMID:Coagulation challenges after severe injury with hemorrhagic shock. 2269 46

We present a case of a 22-year-old male who, in a suicide attempt, ingested approximately 200 g of potassium chlorate. Upon admission to the hospital, he presented in full respiratory failure with cyanosis. Methylene blue antidote was given but found to be ineffective. The patient was intubated and mechanical ventilation was initiated. Because of renal failure with anuria, intermittent haemodialysis (iHD) followed by continuous venovenous hemodiafiltration (CVVHDF) was performed. His hospital stay was also complicated by hemolysis, disseminated intravascular coagulation, and atrial fibrillation. Transfusions of packed red blood cells, platelets, and fresh frozen plasma were necessary to correct the deficits. He also developed liver failure and required two sessions of molecular adsorbent recirculating system (MARS) therapy. On day 14 of his hospitalization, he regained consciousness, as well as full respiratory and circulatory function. There are no controlled studies addressing management of potassium chlorate poisoning. We suggest that early renal replacement therapy should be strongly considered.
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PMID:Suicidal intoxication with potassium chlorate successfully treated with renal replacement therapy and extracorporeal liver support. 2324 35


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