Van Hove Sam, Werion Alexis, Anantharajah Ahalieyah, Belkhir Leila, van Dievoet Marie-Astrid, Hantson Philippe
Department of Intensive Care, Cliniques Universitaires Saint-Luc, 1200 Brussels, Belgium.
Institut de Recherche Expérimentale et Clinique (IREC), Université Catholique de Louvain, Neuve, Belgium.
Case Rep Infect Dis. 2023 Apr 29;2023:3283606. doi: 10.1155/2023/3283606. eCollection 2023.
A 43-year-old woman with a medical history of splenectomy for immune thrombocytopenic purpura was diagnosed with bacteremia. Her initial complaints were fever and more importantly painful extremities that appeared cyanotic. During her hospitalisation, she never developed cardiocirculatory failure but presented acute kidney injury (AKI) with oliguria. Laboratory investigations confirmed AKI with serum creatinine 2.55 mg/dL which peaked at 6.49 mg/dL. There was also evidence for disseminated intravascular coagulation (DIC) with decreased platelet count, low fibrinogen levels, and high D-dimer levels. There were no signs of haemolytic anaemia. The initial ADAMTS13 activity was low (17%) but slowly recovered. Renal function progressively improved with supportive therapy, as opposed to the progressing skin necrosis. The association of DIC and low ADAMTS13 activity may have contributed to the severity of microthrombotic complications, even in the absence of thrombotic microangiopathy as thrombotic thrombocytopenic purpura (TTP) or pneumococcal-associated haemolytic uremic syndrome (pa-HUS).
一名43岁女性，有因免疫性血小板减少性紫癜行脾切除术的病史，被诊断为菌血症。她最初的症状是发热，更重要的是出现四肢疼痛且呈青紫色。住院期间，她从未发生心循环衰竭，但出现了急性肾损伤（AKI）并伴有少尿。实验室检查确诊为AKI，血清肌酐为2.55mg/dL，最高达到6.49mg/dL。同时也有弥散性血管内凝血（DIC）的证据，表现为血小板计数降低、纤维蛋白原水平降低和D-二聚体水平升高。没有溶血性贫血的迹象。最初的ADAMTS13活性较低（17%），但随后缓慢恢复。与皮肤坏死进展相反，肾功能通过支持治疗逐渐改善。DIC与低ADAMTS13活性的关联可能导致了微血栓并发症的严重程度，即使在没有血栓性微血管病如血栓性血小板减少性紫癜（TTP）或肺炎球菌相关溶血尿毒症综合征（pa-HUS）的情况下也是如此。
