Cargando…
Spontaneous heparin-induced thrombocytopenia syndrome presenting as bilateral adrenal infarction after knee arthroplasty
Adrenal gland infarction resulting from adrenal vein thrombosis is an infrequently recognised entity with a limited differential diagnosis. When bilateral, it can result in acute life-threatening adrenal failure. Heparin-induced thrombocytopenia (HIT) is an antibody-mediated, prothrombotic state tha...
Autores principales: | , , , |
---|---|
Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
BMJ Publishing Group
2019
|
Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6936455/ https://www.ncbi.nlm.nih.gov/pubmed/31888903 http://dx.doi.org/10.1136/bcr-2019-232769 |
_version_ | 1783483730919161856 |
---|---|
author | VanderVeer, Elysha A Torbiak, Raymond P Prebtani, Ally PH Warkentin, Theodore E |
author_facet | VanderVeer, Elysha A Torbiak, Raymond P Prebtani, Ally PH Warkentin, Theodore E |
author_sort | VanderVeer, Elysha A |
collection | PubMed |
description | Adrenal gland infarction resulting from adrenal vein thrombosis is an infrequently recognised entity with a limited differential diagnosis. When bilateral, it can result in acute life-threatening adrenal failure. Heparin-induced thrombocytopenia (HIT) is an antibody-mediated, prothrombotic state that represents an important cause of adrenal vein thrombosis leading to associated infarction. Sometimes, the clinical picture of HIT—including the presence of HIT antibodies—occurs despite absence of proximate heparin exposure (‘spontaneous HIT syndrome’). We report a case of nearly missed adrenal failure secondary to bilateral adrenal infarction that evolved during the second week following knee arthroplasty (a known trigger of spontaneous HIT syndrome). The combination of bilateral adrenal infarction, thrombocytopenia and presence of platelet-activating HIT antibodies not explainable by preceding heparin exposure led to a diagnosis of postknee arthroplasty spontaneous HIT syndrome. The case also highlights the clinical and laboratory findings associated with rapidly progressive acute adrenal failure. |
format | Online Article Text |
id | pubmed-6936455 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2019 |
publisher | BMJ Publishing Group |
record_format | MEDLINE/PubMed |
spelling | pubmed-69364552020-01-06 Spontaneous heparin-induced thrombocytopenia syndrome presenting as bilateral adrenal infarction after knee arthroplasty VanderVeer, Elysha A Torbiak, Raymond P Prebtani, Ally PH Warkentin, Theodore E BMJ Case Rep Rare Disease Adrenal gland infarction resulting from adrenal vein thrombosis is an infrequently recognised entity with a limited differential diagnosis. When bilateral, it can result in acute life-threatening adrenal failure. Heparin-induced thrombocytopenia (HIT) is an antibody-mediated, prothrombotic state that represents an important cause of adrenal vein thrombosis leading to associated infarction. Sometimes, the clinical picture of HIT—including the presence of HIT antibodies—occurs despite absence of proximate heparin exposure (‘spontaneous HIT syndrome’). We report a case of nearly missed adrenal failure secondary to bilateral adrenal infarction that evolved during the second week following knee arthroplasty (a known trigger of spontaneous HIT syndrome). The combination of bilateral adrenal infarction, thrombocytopenia and presence of platelet-activating HIT antibodies not explainable by preceding heparin exposure led to a diagnosis of postknee arthroplasty spontaneous HIT syndrome. The case also highlights the clinical and laboratory findings associated with rapidly progressive acute adrenal failure. BMJ Publishing Group 2019-12-29 /pmc/articles/PMC6936455/ /pubmed/31888903 http://dx.doi.org/10.1136/bcr-2019-232769 Text en © BMJ Publishing Group Limited 2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/. |
spellingShingle | Rare Disease VanderVeer, Elysha A Torbiak, Raymond P Prebtani, Ally PH Warkentin, Theodore E Spontaneous heparin-induced thrombocytopenia syndrome presenting as bilateral adrenal infarction after knee arthroplasty |
title | Spontaneous heparin-induced thrombocytopenia syndrome presenting as bilateral adrenal infarction after knee arthroplasty |
title_full | Spontaneous heparin-induced thrombocytopenia syndrome presenting as bilateral adrenal infarction after knee arthroplasty |
title_fullStr | Spontaneous heparin-induced thrombocytopenia syndrome presenting as bilateral adrenal infarction after knee arthroplasty |
title_full_unstemmed | Spontaneous heparin-induced thrombocytopenia syndrome presenting as bilateral adrenal infarction after knee arthroplasty |
title_short | Spontaneous heparin-induced thrombocytopenia syndrome presenting as bilateral adrenal infarction after knee arthroplasty |
title_sort | spontaneous heparin-induced thrombocytopenia syndrome presenting as bilateral adrenal infarction after knee arthroplasty |
topic | Rare Disease |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6936455/ https://www.ncbi.nlm.nih.gov/pubmed/31888903 http://dx.doi.org/10.1136/bcr-2019-232769 |
work_keys_str_mv | AT vanderveerelyshaa spontaneousheparininducedthrombocytopeniasyndromepresentingasbilateraladrenalinfarctionafterkneearthroplasty AT torbiakraymondp spontaneousheparininducedthrombocytopeniasyndromepresentingasbilateraladrenalinfarctionafterkneearthroplasty AT prebtaniallyph spontaneousheparininducedthrombocytopeniasyndromepresentingasbilateraladrenalinfarctionafterkneearthroplasty AT warkentintheodoree spontaneousheparininducedthrombocytopeniasyndromepresentingasbilateraladrenalinfarctionafterkneearthroplasty |