title: Endogenous Heparinoids May Cause Bleeding in Mucor Infection and can be Detected by Nonactivated Thromboelastometry and Treated by Recombinant Activated Factor VII: A Case Report.
abstract: Mucormycosis is an aggressive fungal infection, which invades endothelial cells of blood vessels. This condition might lead to destruction of endothelium and release of heparin-like substances to the bloodstream and cause life-threatening bleeding, which is not well described in the literature.We present a patient with mucormycosis who experienced life-threatening bleeding, although no standard laboratory test could detect any coagulopathy.The cause of bleeding-coagulopathy was detected only by nonactivated thromboelastometry (NATEM), which revealed the presence of heparin-like substances. After treatment with recombinant activated FVII rotational thromboelastometry, results improved and the patient stopped bleeding. Regular application of the drug was necessary during acute phase of infection to prevent further bleeding.In this case report, we show that NATEM can detect the presence of heparin-like substances in bleeding patient with mucormycosis infection and that recombinant activated FVII can be used to stop and prevent bleeding until infection resolves.
authors.affiliation: From the Department of Anesthesiology and Intensive Care Medicine, Second Faculty of Medicine, Charles University and University Hospital Motol (MD, PP), Department of Clinical Haematology, Motol University Hospital (IH), Department of Paedriatric Surgery (JN), and Department of Paediatric Haematology and Oncology, Second Faculty of Medicine, Charles University and University Hospital Motol, Prague, Czech Republic (DJ).
authors.forename: Miroslav
authors.initials: M
authors.lastname: Durila
authors.forename: Petr
authors.initials: P
authors.lastname: Pavlicek
authors.forename: Ivana
authors.initials: I
authors.lastname: Hadacova
authors.forename: Jiri
authors.initials: J
authors.lastname: Nahlovsky
authors.forename: Daniela
authors.initials: D
authors.lastname: Janeckova
mesh_terms: D000935:Antifungal Agents / Q000627:therapeutic use; D001780:Blood Coagulation Tests; D002648:Child; D004322:Drainage / Q000009:adverse effects; D015942:Factor VIIa / Q000627:therapeutic use*; D005260:Female; D006470:Hemorrhage / Q000209:etiology / Q000628:therapy*; D006496:Heparinoids / Q000378:metabolism*; D006801:Humans; D007049:Iatrogenic Disease; D009091:Mucormycosis / Q000188:drug therapy* / Q000378:metabolism; D011994:Recombinant Proteins / Q000627:therapeutic use; D013154:Spleen / Q000293:injuries / Q000601:surgery; D013156:Splenectomy
chemical_list: D000935:Antifungal Agents; D006496:Heparinoids; D011994:Recombinant Proteins; C103587:recombinant FVIIa; D015942:Factor VIIa