title: A 61-year-old man with disseminated intravascular coagulation: a case report.
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.
authors: Department of Vascular and Endovascular Surgery, University Hospital Düsseldorf, Düssedorf, Germany. Electronic address: markus.wagenhaeuser@med.uni-duesseldorf.de.
authors: Markus U
authors: MU
authors: Wagenhäuser
authors: Department of Vascular and Endovascular Surgery, University Hospital Düsseldorf, Düssedorf, Germany.
authors: Neshlian
authors: N
authors: Ertas
authors: Department of Vascular and Endovascular Surgery, University Hospital Düsseldorf, Düssedorf, Germany.
authors: Tolga A
authors: TA
authors: Sagban
authors: Department of Vascular and Endovascular Surgery, University Hospital Düsseldorf, Düssedorf, Germany.
authors: Mareike
authors: M
authors: Witte
authors: Department of Hemostaseology, University Hospital Düsseldorf, Düssedorf, Germany.
authors: Till
authors: T
authors: Hoffman
authors: Department of Vascular and Endovascular Surgery, University Hospital Düsseldorf, Düssedorf, Germany.
authors: Hubert
authors: H
authors: Schelzig
authors: Department of Vascular and Endovascular Surgery, University Hospital Düsseldorf, Düssedorf, Germany.
authors: Alexander
authors: A
authors: Oberhuber
mesh_terms: D000671:Amputation, Surgical; D000818:Animals; D000925:Anticoagulants / Q000008:administration & dosage; D000935:Antifungal Agents / Q000627:therapeutic use; D010856:Columbidae; D003453:Cryptococcosis / Q000097:blood / Q000175:diagnosis / Q000382:microbiology* / Q000628:therapy; D003454:Cryptococcus / Q000472:pathogenicity*; D004211:Disseminated Intravascular Coagulation / Q000097:blood / Q000175:diagnosis / Q000628:therapy; D004334:Drug Administration Schedule; D005243:Feces / Q000382:microbiology*; D006801:Humans; D019570:Inhalation Exposure / Q000009:adverse effects; D007511:Ischemia / Q000097:blood / Q000175:diagnosis / Q000382:microbiology* / Q000628:therapy; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D012720:Severity of Illness Index; D013927:Thrombosis / Q000097:blood / Q000175:diagnosis / Q000382:microbiology* / Q000628:therapy; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
chemical_list: D000925:Anticoagulants; D000935:Antifungal Agents