phenylephrine-hydrochloride and Disseminated-Intravascular-Coagulation

Coronavirus disease 2019 (COVID-19) related coagulopathy may be the first clinical manifestation even in non-vasculopathic patients and is often associated with worse clinical outcomes.. A 78 years old woman was admitted to the Emergency Unit with respiratory symptoms, confusion and cyanosis at the extremity, in particular at the nose area, hands and feet fingers. A nasal swab for COVID-19 was performed, which resulted positive, and so therapy with doxycycline, hydroxychloroquine and antiviral agents was started. At admission, the patient was hemodynamically unstable requiring circulatory support with liquids and norepinephrine; laboratory tests showed disseminated intravascular coagulation (DIC). During hospitalization, the clinical condition worsened and the cyanosis of the nose, fingers, and toes rapidly increased and became dried gangrene in three days. Subsequently, the neurological state deteriorated into a coma and the patient died.. In severe cases, COVID-19 could be complicated by acute respiratory disease syndrome, septic shock, and multi-organ failure. This case report shows the quick development of dried gangrene in a non-vasculopathic patient, as a consequence of COVID-19's coagulopathy and DIC.. In our patient, COVID-19 related coagulopathy was associated with poor prognosis.

Topics: Acute Disease; Aged; Antiviral Agents; Betacoronavirus; Coronavirus Infections; COVID-19; Disseminated Intravascular Coagulation; Doxycycline; Female; Fingers; Gangrene; Humans; Hydroxychloroquine; Nasal Cavity; Nose; Pandemics; Pneumonia, Viral; SARS-CoV-2; Severity of Illness Index

Topics: Abortion, Septic; Adult; Bacteremia; Critical Care; Disseminated Intravascular Coagulation; Escherichia coli; Escherichia coli Infections; Female; Humans; Nose; Pregnancy; Purpura Fulminans; Shock, Septic; Skin Diseases

We report on a patient with Sharp-Syndrome who was referred to our emergency department with sepsis. In addition, the patient showed acral necrosis, particularly of the distal phalanges of the hands and of the tip of the nose.. Laboratory analyses showed an elevation of the inflammatory parameters (C-reactive protein elevation, leukocytosis). Furthermore, procalcitonin and the D-dimers were increased, antithrombin III, however, was decreased. The thoracic/abdominal computed tomography (CT) showed bilateral inferior lobe pneumonia with concomitant pleural effusions. As a secondary diagnostic finding the thoracic/abdominal CT and the abdominal ultrasound showed a markedly reduced size of the spleen. Finally, bacteria (Streptococcus pneumoniae) were found in the blood of the patient.. We diagnosed pneumococcal sepsis with disseminated intravasal coagulation and acral necrosis caused by pneumonia. The immune status was impaired due to immunosuppressive therapy (prednisolon and azathioprin) and functional asplenism. The patient was stabilized with antibiotic treatment, hydration, and drotrecogin (protein C). Transiently catecholamin treatment and oxygen substitution were necessary. Alprostadil was used to treat acral circulatory disorder.. This case report shows the importance of consequent screening for organ manifestations in autoimmune diseases. In particular, this case report highlights the relevance of prophylactic vaccination in patients with autoimmune diseases, primarily those with autosplenectomy. Furthermore, this article gives a short overview about the pathogenesis, the diagnostic criteria of the Sharp-syndrome. The frequencies of organ involvement and the treatment options are also discussed.

Topics: Disseminated Intravascular Coagulation; Female; Fingers; Humans; Immunosuppressive Agents; Mixed Connective Tissue Disease; Necrosis; Nose; Pneumococcal Infections; Sepsis; Streptococcus pneumoniae; Young Adult

Topics: Aged; Blood Coagulation Tests; Cyanosis; Disseminated Intravascular Coagulation; Female; Heparin; Humans; Leg Ulcer; Male; Nose; Skin Diseases; Thrombocytopenia