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Disseminated Intravascular Coagulation: As Presenting Feature in Patients

with Systemic Lupus Erythematosus - Two Case Reports

Article in Journal of Medical Science And clinical Research · August 2015

DOI: 10.18535/jmscr/v3i8.24

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Umashankar Mishra Chitta Ranjan Khatua

Maharaja Krishna Chandra Gajapati Medical College and Hospital Maharaja Krushna Chandra Gajapati Medical College
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DOI: http://dx.doi.org/10.18535/jmscr/v3i8.24

Disseminated Intravascular Coagulation: As Presenting Feature in Patients

with Systemic Lupus Erythematosus - Two Case Reports

Authors
Mishra U S , Khatua C R2, Patro D3, Arun S V4, Satya K5
1
1
Associate Professor, 2Assistant Professor, 3Senior Resident, 4,5Post Graduate Student

ABSTRACT
There are different types of initial manifestation of systemic lupus erythematosus (SLE) like rash, oral ulcers,
joint pain, anaemia and repeated abortions1,2,3 but presenting with fever altered sensorium4,5, hepatopathy,
hypotension and bleeding disorder9,10 can be rare initial clinical presentations in both new and diagnosed
patients of SLE. We present two patients of SLE with this rare manifestation.
Key Words: Systemic lupus erythematosus (SLE), Disseminated intravascular coagulation (DIC), multiorgan
dysfunction syndrome (MODS).

INTRODUCTION and petechae all over body. Clinical examination

We report two patients admitted with hypotension revealed hypotension (SBP90mmHg), altered
and altered sensorium, petechae all over body with sensorium. No abnormalities were found in the
bleeding from gum and vagina. Both the patients cardiovascular, respiratory or abdominal systems.
were initially treated in the line of sepsis with She had oral ulcers and SLE was diagnosed 15
DIC. Disseminated intravascular coagulation is days back.
commonly associated with sepsis, cancer, Her labs revealed Hemoglobin of 5.2g/dl, WBC
obstetric complications, shock, snake bite and count of 3.8x10 3/uL and platelet count of
burn injuries11. But the condition did not improve 70x103/uL. ESR was 40mm in first hour. Serum
and as the first patient was diagnosed as SLE creatinine was 3 mg/dL, liver function test was
15days back and no other cause for DIC besides total bilirubin-1.5, AST-350, ALT-300, ALP-245,
SLE could be established, she was treated with low fibrinogen and increased in fibrin degradation
injection methyleprednisolone, which rapidly product (FDPs-312/ uL) level, CSF examination
improved the condition. Similar event happened in was normal. X-ray chest, CT scan brain were
the second patient and improved only after normal. She was treated with dopamine,
receiving methyleprednisolone. noradrenaline, antibiotics, transfusion of whole
blood, platelet rich plasma and FFP (fresh frozen
CASE NO-1 plasma) on the suspicion of pancytopenia, sepsis
A young lady of 19 years was admitted with with DIC. Her clinical conditions did not improve
altered sensorium, gum bleeding, vaginal bleeding with treatment. In absence of other cause for DIC
Mishra U S et al JMSCR Volume 03 Issue 08 August Page 7045
JMSCR Vol.||03||Issue||08||Page 7045-7047||August 2015
she was treated for SLE with injection was normal clinically and still on regular follow
methylprednisolone (1gm/d), which rapidly up.
corrected the DIC as well as the other
manifestations of SLE like hypotension, DISCUSSION
pancytopenia, renal failure and bleeding disorder. We report two young women with SLE presented
with pancytopenia, bleeding disorder,
CASE NO-2 hypotension, renal failure, liver dysfunction and
A 35year old lady admitted with similar CNS manifestation which did not respond to
presentation of altered sensorium, gum and standard treatment for common diseases like
vaginal bleeding, petechae all over body and sepsis with DIC but improved with injection
fever. Clinical examination revealed fever (102oF) methylprednisolone(1gm/d). The main clinical
,hypotension(S.B.P 80mmHg), altered sensorium, categories of DIC are commonly associated with
planters were non responsive with no neck sepsis mostly with gram negative septicemia,
rigidity. No abnormalities were found in the cancer like AML and pancreatic carcinoma,
cardiovascular, respiratory or abdominal systems. obstetric complications, snake bite and burn
She had also oral ulcers and alopecia for last one injuries11. In a retrospective study of a series of
year. No medical attention was sought for these 129 SLE patients, eight of whom developed DIC
complaints. during the course of this disease, and common risk
Her labs revealed Hemoglobin of 6.4g/dl, WBC parameters, present at the time of first medical
count of 3.2x10 3/uL and platelet count of examination, were leukopenia infection and male
60x103/uL. ESR was 30mm in first hour. On sex. 12 Although infectious, malignancy and
admission serum creatinine was 3.8 mg/dL, liver obstetric complications remain the most common
function test was total bilirubin-1.3,AST- cause of DIC; SLE should one of the important
595,ALT-336,ALP-299, test for malaria parasite differential diagnoses in certain clinical settings.
was negative both slide and ICT,CSF examination
was normal. X-ray chest, CT scan brain were CONCLUSION
normal but the fibrin degradation product (FDPs- Since acute disseminated intravascular
318/ uL) level was raised. Initially she was treated coagulation (DIC) often contributes to a fatal
with dopamine, noradrenaline, piperacilline- outcome in patients with systemic lupus
tazobactum, transfusion of whole blood, platelet erythematosus (SLE), prediction of its
rich plasma and FFP (fresh frozen plasma) on the development is important to prevent the
suspicion of sepsis with DIC. But her clinical occurrence of such an event in absence of other
condition did not improve and developed seizure causes of DIC.12
on 5th day of admission, so autoimmune profile
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