title: Bilateral adrenal haemorrhage associated with heparin-induced thrombocytopaenia during treatment of Fournier gangrene.
abstract: We present a case of bilateral adrenal haemorrhage (BAH) associated with heparin-induced thrombocytopaenia (HIT) in a 61-year-old man admitted to hospital for the treatment of Fournier's gangrene. He presented to hospital with scrotal swelling and fever, and developed spreading erythaema and a gangrenous scrotum. His scrotum was surgically debrided and intravenous broad-spectrum antibiotics were administered. Unfractionated heparin was given postoperatively for venous thromboembolism prophylaxis. The patient deteriorated clinically 8-11 days postoperatively with delirium, chest pain and severe hypertension followed by hypotension and thrombocytopaenia. Abdominal CT scan revealed bilateral adrenal haemorrhage. Antibodies to the heparin-platelet factor 4 complex were present. HIT-associated BAH was diagnosed and heparin was discontinued. Intravenous bivalirudin and hydrocortisone were started, with rapid improvement in clinical status. BAH is a rare complication of HIT and should be considered in the postoperative patient with unexplained clinical deterioration.
authors.affiliation: School of Medicine, University of Queensland, Herston, Queensland, Australia.
authors.forename: Timothy Lee
authors.initials: TL
authors.lastname: Tattersall
authors.affiliation: Department of Urology, University of Queensland, Herston, Queensland, Australia.
authors.forename: Isaac A
authors.initials: IA
authors.lastname: Thangasamy
authors.affiliation: Department of Urology, Royal Brisbane & Women's Hospital, Herston, Queensland, Australia.
authors.forename: Jamie
authors.initials: J
authors.lastname: Reynolds
mesh_terms: D000307:Adrenal Gland Diseases / Q000139:chemically induced*; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D000925:Anticoagulants / Q000009:adverse effects*; D003646:Debridement; D018934:Fournier Gangrene / Q000188:drug therapy / Q000601:surgery*; D006470:Hemorrhage / Q000139:chemically induced*; D006493:Heparin / Q000009:adverse effects*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011182:Postoperative Care; D012611:Scrotum / Q000601:surgery*; D013921:Thrombocytopenia / Q000139:chemically induced*; D013923:Thromboembolism / Q000517:prevention & control
chemical_list: D000900:Anti-Bacterial Agents; D000925:Anticoagulants; D006493:Heparin