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...

Descripción completa

Detalles Bibliográficos
Autores principales: VanderVeer, Elysha A, Torbiak, Raymond P, Prebtani, Ally PH, Warkentin, Theodore E
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