fibrin and Fever

Forensic investigations generally contain extensive morphological examinations to accurately diagnose the cause of death. Thus, the appearance of a new disease often creates emerging challenges in morphological examinations due to the lack of available data from autopsy- or biopsy-based research. Since late December 2019, an outbreak of a novel seventh coronavirus disease has been reported in China caused by "severe acute respiratory syndrome coronavirus 2" (SARS-CoV-2). On March 11, 2020, the new clinical condition COVID-19 (Corona-Virus-Disease-19) was declared a pandemic by the World Health Organization (WHO). Patients with COVID-19 mainly have a mild disease course, but severe disease onset might result in death due to proceeded lung injury with massive alveolar damage and progressive respiratory failure. However, the detailed mechanisms that cause organ injury still remain unclear. We investigated the morphological findings of a COVID-19 patient who died during self-isolation. Pathologic examination revealed massive bilateral alveolar damage, indicating early-phase "acute respiratory distress syndrome" (ARDS). This case emphasizes the possibility of a rapid severe disease onset in previously mild clinical condition and highlights the necessity of a complete autopsy to gain a better understanding of the pathophysiological changes in SARS-CoV-2 infections.

Topics: Alveolar Epithelial Cells; Autopsy; Betacoronavirus; Coronavirus Infections; Cough; COVID-19; Diabetes Mellitus, Type 2; Fever; Fibrin; Fibrosis; Humans; Hyperplasia; Hypertension; Lung; Lymphocytes; Macrophages; Male; Megakaryocytes; Metaplasia; Middle Aged; Neutrophils; Pandemics; Pneumonia, Viral; Quarantine; SARS-CoV-2; Tachycardia; Thrombosis

BACKGROUND Radiofrequency ablation is a minimally invasive treatment for arrhythmias, including frequent ventricular premature. As a complication of radiofrequency ablation, pseudoaneurysm can be treated conservatively or by ultrasound-guided thrombin injection. CASE REPORT We report a case that a possible allergic reaction to thrombin injected into pseudoaneurysm after radiofrequency ablation. CONCLUSIONS We hope that the report of successful management of the allergic reaction in this case may be of help to other doctors; we also emphasize the importance of checking the patient's history of allergies to thrombin when considering treating pseudoaneurysm with thrombin injection.

Topics: Aged, 80 and over; Alanine Transaminase; Aneurysm, False; Drug Hypersensitivity; Electrocardiography; Female; Femoral Artery; Fever; Fibrin; Fibrin Fibrinogen Degradation Products; Hemoglobins; Hemostatics; Humans; Hypotension; Injections, Intra-Arterial; Leukopenia; Nausea; Radiofrequency Ablation; Thrombin; Thrombocytopenia; Ventricular Premature Complexes

BACKGROUND Acute fibrinous and organizing pneumonia (AFOP) is a newly evolving rare non-infectious lung pathology, characterized by intra-alveolar fibrin balls on histology. It is often difficult to diagnose and is usually mistaken for other lung pathologies. We present an interesting case of AFOP with unusual radiologic findings and disease course. CASE REPORT A 56-year-old woman presented with a 1-day history of high-grade fever, chills, and profuse sweating. She was febrile to 101.2 degree Fahrenheit on presentation. On physical examination, she had decreased air entry in the left upper lobe of the lung. Laboratory testing showed a white cell count of 27,000 cells per microliter of blood with left shift. A chest radiograph showed a left upper lobe consolidation. Computed tomography (CT) of the chest without intravenous contrast showed advanced centrilobular emphysema and left upper lobe consolidation measuring 6.2×5.9 cm. The patient was started on antibiotics. She clinically improved and was discharged on oral antibiotics. After discharge, a trans-bronchial lung biopsy showed acute inflammatory cell infiltrate with intra-alveolar fibrin balls but no hyaline membrane formation or significant eosinophils. These findings were consistent with acute fibrinous and organizing pneumonia. However, she was subsequently lost to follow-up. CONCLUSIONS Our case adds to the literature a new and unusual finding of upper lobe infiltrates, in contrast to most cases presenting as bilateral lower lobe infiltrates. In our case, symptomatic improvement after antibiotic treatment suggests a possible role of antibiotics in management of this entity.

Topics: Chills; Female; Fever; Fibrin; Humans; Lung; Middle Aged; Pneumonia; Pulmonary Emphysema; Sweating

Topics: Anti-Bacterial Agents; Biopsy; Community-Acquired Infections; Cryptogenic Organizing Pneumonia; Diagnosis, Differential; Female; Fever; Fibrin; Glucocorticoids; Humans; Legionella pneumophila; Legionnaires' Disease; Levofloxacin; Lung; Lung Diseases, Interstitial; Middle Aged; Pneumonia; Prednisolone; Radiography; Rare Diseases; Tomography, X-Ray Computed; Treatment Outcome

A procoagulant state is implicated in cerebral malaria (CM) pathogenesis, but whether disseminated intravascular coagulation (DIC) is present or associated with a fatal outcome is unclear.. To determine the frequency of overt DIC, according to ISTH criteria, in children with fatal and non-fatal CM.. Malawian children were recruited into a prospective cohort study in the following diagnostic groups: retinopathy-positive CM (n = 140), retinopathy-negative CM (n = 36), non-malarial coma (n = 14), uncomplicated malaria (UM), (n = 91), mild non-malarial febrile illness (n = 85), and healthy controls (n = 36). Assays in the ISTH DIC criteria were performed, and three fibrin-related markers, i.e. protein C, antithrombin, and soluble thrombomodulin, were measured.. Data enabling assignment of the presence or absence of 'overt DIC' were available for 98 of 140 children with retinopathy-positive CM. Overt DIC was present in 19 (19%), and was associated with a fatal outcome (odds ratio [OR] 3.068; 95% confidence interval [CI] 1.085-8.609; P = 0.035]. The levels of the three fibrin-related markers and soluble thrombomodulin were higher in CM patients than in UM patients (all P < 0.001). The mean fibrin degradation product level was higher in fatal CM patients (71.3 μg mL(-1) [95% CI 49.0-93.6]) than in non-fatal CM patients (48.0 μg mL(-1) [95% CI 37.7-58.2]; P = 0.032), but, in multivariate logistic regression, thrombomodulin was the only coagulation-related marker that was independently associated with a fatal outcome (OR 1.084 for each ng mL(-1) increase [95% CI 1.017-1.156]; P = 0.014). Despite these laboratory derangements, no child in the study had clinically evident bleeding or thrombosis. An overt DIC score and high thrombomodulin levels are associated with a fatal outcome in CM, but infrequently indicate a consumptive coagulopathy.

Topics: Biomarkers; Blood Glucose; Child; Child, Preschool; Coma; Disseminated Intravascular Coagulation; Female; Fever; Fibrin; Hematologic Tests; Humans; Infant; Lactates; Malaria, Cerebral; Malaria, Falciparum; Malawi; Male; Parasitemia; Prospective Studies; Retinal Hemorrhage; Risk Factors; Thrombomodulin

The plasma levels of D-dimer can be used as a marker of fibrin formation and degradation. Plasma D-dimer levels in the febrile phase of 6 patients with typhoid fever and in the afebrile convalescent phase of 4 of them were measured. D-dimer levels were high in the febrile phase of all 6 patients and within normal range in the afebrile convalescent phase of all 4 patients. Our results indicate that thrombus formation and fibrinolysis may occur in the febrile phase of patients with typhoid fever.

Topics: Adolescent; Adult; Female; Fever; Fibrin; Fibrin Fibrinogen Degradation Products; Humans; Male; Thrombosis; Typhoid Fever

Circulating D-dimer and thrombomodulin (TM) levels are now routinely measured in clinical laboratories. Plasma levels of D-dimer are used as a marker of fibrin formation and degradation, and serum TM is used to assess the state of endothelial cell injuries. While the levels of circulating D-dimer and TM have been investigated in many diseases, to our knowledge they have not been studied in patients with measles. We measured circulating levels of D-dimer in patients with measles to discuss whether fibrin formation and degradation occur and TM whether endothelial injury occur.. The plasma levels of D-dimer and serum levels of alanine aminotransferase (ALT) and creatinine were measured of 14 adolescent and adult Japanese patients with measles, and the serum or plasma levels of TM of 10 of these 14 patients were measured in the acute febrile phase and convalescent afebrile phase with commercially available kits.. Plasma D-dimer levels were significantly higher in the acute febrile phase than in the convalescent afebrile phase in patients with measles, and no significant difference was shown in serum and plasma TM levels between the two phases. Plasma D-dimer levels were not correlated with serum or plasma TM levels in either phase. No significant differences were identified in the serum ALT and creatinine levels between the acute febrile and convalescent afebrile phases, and the levels of plasma D-dimer were not significantly correlated with the serum ALT levels.. Our results indicate that while clot formation and fibrinolysis may tend to occur in patients with the acute febrile phase of measles, there may be little risk that such patients will suffer endothelial injury.

Topics: Acute Disease; Acute-Phase Reaction; Adolescent; Adult; Alanine Transaminase; Convalescence; Creatinine; Endothelium; Fever; Fibrin; Fibrin Fibrinogen Degradation Products; Humans; Measles; Morbillivirus; Thrombomodulin

In two young patients with an elevated temperature, a girl aged 6 months and a boy aged 10 months, purpura and oedema were noticed on the face, ears, arms and legs. On one occasion the boy lost blood anally. A histopathological examination revealed leucocytoclastic vasculitis with fibrin deposits. The diagnosis was 'acute haemorrhagic oedema of infancy' (AHOI), a relatively unknown variant of palpable purpura due to leucocytoclastic vasculitis affecting infants and young children (up to two years of age). AHOI is characterised clinically by marked oedema and fever as well as large palpable purpuric and ecchymotic skin lesions in a target-like pattern mainly on the face, ears and extremities. The skin lesions heal spontaneously within one to three weeks and internal organs are rarely affected. This is in contrast to Henoch-Schönlein purpura, which was observed in a 5-year old boy suffering from similar skin lesions on the legs as well as painful joints, in whom IgA deposits were found in the vasculitis. Henoch-Schönlein purpura is clinically characterised by palpable purpura on the extensor surfaces of the legs and on the buttocks, whereas in AHOI larger purpura and ecchymoses are found on the face, ankles and wrists, with far more extensive oedema. There are also histological differences: in AHOI there is more extensive vasculitis with fibrin deposits and IgA deposits are seen in a minority of cases. Awareness of this relatively unknown form of leucocytoclastic vasculitis will assist in making an early diagnosis possible, thereby avoiding unnecessary treatment and concern.

Topics: Acute Disease; Child, Preschool; Diagnosis, Differential; Ecchymosis; Edema; Female; Fever; Fibrin; Humans; IgA Vasculitis; Immunoglobulin A; Infant; Male; Purpura; Skin; Syndrome; Vasculitis, Leukocytoclastic, Cutaneous

Two patients who developed reversible renal failure during intermittent rifampicin therapy are described. Both had febrile reactions to rifampicin. The first was also found to have uraemia associated with swelling of the glomerular endothelial cells. The second developed tubular necrosis unassociated with haemolysis or shock. The pathogenesis of the renal lesion in these two patients, as revealed by light microscopy, immunofluorescence studies and electron microscopy, is discussed.

Topics: Acute Kidney Injury; Adult; Antibodies; Endothelium; Ethambutol; Fever; Fibrin; Humans; Immune Complex Diseases; Ischemia; Kidney Glomerulus; Kidney Tubules; Male; Necrosis; Rifampin; Tuberculosis, Pulmonary; Uremia

Topics: Blood Coagulation Factors; Disseminated Intravascular Coagulation; Fever; Fibrin; Fibrinolysis; Hemorrhage; Heparin; Humans; Liver; Sunstroke; Temperature; Thrombocytopenia

Prolonged coma due to acute overdosage with hypnotic drugs is shown to be associated with a pronounced increase in the activity of serum creatine kinase and in the concentration of fibrin degradation products and with less pronounced abnormalities of other serum enzymes and of other indices of coagulation and fibrinolysis. Evidence is presented that skeletal muscle damage occurs and that this is related to the coagulation abnormality. These findings probably explain some of the non-specific features such as fever which commonly occur in recovery from severe poisoning.

Topics: Adult; Aged; Alanine Transaminase; Amitriptyline; Aspartate Aminotransferases; Blood Coagulation; Blood Platelets; Coma; Creatine Kinase; Enzymes; Female; Fever; Fibrin; Fibrinogen; Fibrinolysis; Humans; Hydroxybutyrate Dehydrogenase; Hypnotics and Sedatives; L-Lactate Dehydrogenase; Male; Middle Aged; Muscular Diseases; Plasminogen; Serum Globulins

Topics: Animals; Fever; Fibrin; Fibrinogen; Fluorescent Antibody Technique; Humans; Immunodiffusion; Immunoelectrophoresis; Immunosuppressive Agents; Kidney; Kidney Transplantation; Prednisone; Proteinuria; Rabbits; Transplantation Immunology; Transplantation, Homologous