Menstruation-related disseminated intravascular coagulation in an adenomyosis patient: case report and review of the literature

Abstract

Disseminated intravascular coagulation (DIC) is a high mortality coagulopathy that leads to simultaneous thrombotic and bleeding problems. It occurs as a complication in different disease as malignancies, obstetrical catastrophes, bacterial sepsis and traumas. We report on an extremely rare case of acute DIC in a patient with misdiagnosed adenomyosis and massive methrorragia which led to acute kidney failure. The patient was successfully treated with hysterectomy and blood product transfusions; however, a slight reduction of renal function persisted. We were able to confirm the cause-consequence link between adenomyosis and consumptive DIC since we saw the thrombi in the adenomyotic uterus from early hysterectomy specimen. Moreover, this is the first case, for the best of our knowledge, in which systemic consequences persist in an adenomyosis patient who developed a DIC. Early diagnose and treatment of acute DIC is essential for patient’s survival and to prevent severe complications: adenomyosis should be kept in mind as a possible cause of DIC when a patient shows up with massive bleeding.

摘要

弥散性血管内凝血（DIC）是一种高死亡率的凝血病, 可导致同时发生血栓和出血问题。它发生于不同疾病如恶性肿瘤, 产科急重症, 细菌性败血症和创伤的并发症中。我们报告了一例极为罕见的急性DIC病例, 该病例为子宫腺肌病误诊合并重度甲状腺炎导致的急性肾功能衰竭。患者成功接受了子宫切除术和输血治疗; 然而, 持续存在肾功能轻微下降。我们能够确认子宫腺肌病是消耗性DIC的病因, 因为我们从早期子宫切除标本中观察到子宫腺肌瘤的血栓。此外, 据我们所知, 这是子宫腺肌病患者导致DIC病例的首次报道。早期诊断和治疗急性DIC对于患者生存及预防严重并发症至关重要：当患者出现大量出血时, 应谨记子宫腺肌病是DIC的可能原因。

Keywords:

• Adenomyosis
• metrorrhagia
• consumptive coagulopathy
• acute renal failure
• disseminated intravascular coagulation

Acknowledgements

The authors acknowledge Professor Fabrizio Zanconati, head of the Clinical Unit of Pathological Anatomy and Histology University of Trieste for the helpful comments about specimen analysis.

Disclosure statement

No potential conflict of interest was reported by the authors.