A Case of Severe Disseminated Intravascular Coagulation During Pneumococcal Septic Shock

The case: presentation in the emergency room (er)

A 55-year-old man visited the emergency room (ER) of the Maastricht University Medical Centre with sudden onset complaints of disorientation, general malaise, and vomiting the night before. Focal complaints were absent. His prior medical history revealed multiple myeloma since 2006. He was treated twice with high dose chemotherapy with stem cell rescue and finally in 2007, he was transplanted with allogenic stem cells. At the moment he was in complete remission from multiple myeloma. He did not use any medication at the time of presentation in the hospital.

Abstract

A 55-year-old man presented with a pneumococcal pneumonia that evolved into a septic shock. This pneumococcal infection was complicated by severe disseminated intravascular coagulation (DIC) leading to necrosis of several fingertips. The current management of DIC consists of treatment of the underlying disease. In the case of infection, this means fluid resuscitation and broad spectrum antibiotic therapy. In addition, the coagulation cascade is often disturbed by excessive activation and consumption of coagulation proteins and platelets. This requires supportive hemostatic therapy. Recently, the administration of activated protein C (APC) to support the impaired coagulation pathway during sepsis is studied in a number of randomized controlled trials. Although this drug is already approved by the US Food and Drug Administration and the European Community for treatment of patients with severe sepsis, in clinical practice the use of APC is very rare.

Keywords

disseminated intravascular coagulation, septic shock, pneumococcal infection