Gastrointestinal infection-related disseminated intravascular coagulation mimicking Shiga toxin-mediated hemolytic uremic syndrome - implications of classical clinical indexes in making the diagnosis: A case report and literature review

Abstract

BACKGROUND

Thrombocytopenia associated with acute kidney injury is a challenging disorder. Thrombotic microangiopathy (TMA) is a potentially life- or organ-threatening syndrome that can be induced by several disorders or medical interventions. There is overlap between the clinical presentation and pathophysiology of thrombotic thrombocytopenia purpura and hemolytic uremic syndrome (HUS), and to a lesser extent, disseminated intravascular coagulation (DIC). We describe a case to illustrate the potential diagnostic difficulty, especially at initial presentation.

CASE SUMMARY

We reported a case of a 44-year-old woman that presented with diarrhea, thrombocytopenia, schistocytes, elevated serum lactate dehydrogenase (LDH) level and acute kidney injury. While the clinical presentation resembled that of Shiga toxin–induced HUS, the disease course was more consistent with gastrointestinal infection-related DIC. To aid in the accurate diagnosis of TMA and other associated disorders, we have undertaken a review and provided a clear interpretation of some typical biomarkers including schistocytes, LDH and platelet count, coagulation profile and more specific indexes of ADAMTS13, complement profile, and the isolation of Shiga toxin-producing Escherichia coli (commonly referred to as STEC).

CONCLUSION

The use and correct interpretation of classical indexes of schistocyte, LDH, and platelet count is vital in diagnosing TMA and associated disorders. Understanding the characteristics of these biomarkers in the context of thrombocytopenia purpura, HUS and DIC will facilitate the accurate diagnosis and early initiation of appropriate treatment.

Keywords: Thrombotic microangiopathy, Thrombotic thrombocytopenic purpura, Hemolytic uremic syndrome, Schistocyte, Lactate dehydrogenase, Thrombocytopenia, Case report

Core tip: Thrombotic microangiopathy is a severe and challenging disorder. There is overlap between the clinical presentation and pathophysiology of thrombotic thrombocytopenic purpura, hemolytic uremic syndrome, and disseminated intravascular coagulation. Upon literature review, we use a case study to illustrate the characteristics and utility of classical clinical indexes of schistocytes, lactate dehydrogenase, platelet count and coagulation profile in parallel with more specific investigations of ADAMTS13, complement profile, and isolation of Shiga toxin-producing Escherichia coli, in an attempt to facilitate the early recognition and diagnosis of thrombotic microangiopathy.