Successful treatment of sepsis-induced disseminated intravascular coagulation in a patient with idiopathic thrombocytopenic purpura using recombinant human soluble thrombomodulin.
Disseminated intravascular coagulation (DIC) may complicate a variety of disorders that contribute to mortality, particularly those related to bleeding. It is therefore very difficult to manage DIC in patients with known bleeding disorders. We treated a 62-year-old woman with idiopathic thrombocytopenic purpura (ITP) complicated with sepsis-induced DIC. She had been diagnosed with ITP 8 months prior to admission. Laboratory tests showed an elevation of d-dimer and endotoxin, while pyelonephritis was shown by abdominal computed tomography. Escherichia coli was detected by blood culture. Based on these findings, the patient was diagnosed with sepsis-induced DIC due to urinary tract infection. Thrombocytopenia was refractory despite the use of antibiotics and platelet transfusion, but it was promptly improved in response to recombinant human soluble thrombomodulin (rTM). We suggest that rTM provides a new therapeutic strategy for DIC patients with high hemorrhagic risk.
Unit of Translational Medicine, Department of Immunology and Rheumatology, Graduate School of Biomedical Sciences, Nagasaki University, Sakamoto 1-7-1, Nagasaki 852-8501, Japan. tkoga@nagasaki-u.ac.jp
Tomohiro
T
Koga
Daisuke
D
Inoue
Akitomo
A
Okada
Toshiyuki
T
Aramaki
Satoshi
S
Yamasaki
Munetoshi
M
Nakashima
Atsushi
A
Kawakami
Katsumi
K
Eguchi
D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D004211:Disseminated Intravascular Coagulation / Q000097:blood / Q000188:drug therapy* / Q000209:etiology*; D004731:Endotoxins / Q000097:blood; D004927:Escherichia coli Infections / Q000097:blood / Q000175:diagnosis / Q000188:drug therapy; D005260:Female; D005338:Fibrin Fibrinogen Degradation Products / Q000032:analysis; D006801:Humans; D008875:Middle Aged; D016553:Purpura, Thrombocytopenic, Idiopathic / Q000097:blood / Q000188:drug therapy*; D011704:Pyelonephritis / Q000000981:diagnostic imaging; D011859:Radiography; D011994:Recombinant Proteins / Q000627:therapeutic use*; D018805:Sepsis / Q000097:blood / Q000150:complications*; D018180:Thrombomodulin / Q000627:therapeutic use*; D016896:Treatment Outcome
D000900:Anti-Bacterial Agents; D004731:Endotoxins; D005338:Fibrin Fibrinogen Degradation Products; D011994:Recombinant Proteins; C546931:THBD protein, human; D018180:Thrombomodulin; C036309:fibrin fragment D; C044101:endotoxin, Escherichia coli
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