DISSEMINATED INTRAVASCULAR COAGULATION DUE TO TOOTH FOCUS SEPSIS
a Case Report
Keywords:
Coagulopathies, Infection, Dentistry, Case studyAbstract
Introduction: Disseminated intravascular coagulation (DIC) is an acquired coagulopathy characterized by continuous thrombin generation and depletion of coagulation factors and platelets. Occurs as a complication of several disorders, presenting signs of microthrombi and hemorrhages, which may occur simultaneously. The diagnosis is made based on clinical manifestations and laboratory tests. Treatment involves resolving the underlying cause. Objective: To present the history of a patient who, after sepsis of dental focus, developed endocarditis, hematologic decompensation and DIC, aiming to broaden the understanding of the implications of DIC. Materials and Methods: Clinical case analysis compared to a narrative review of the literature in the MEDLINE, PubMed and UpToDate databases, with the descriptors “Disseminated Intravascular Coagulation” and “Sepsis”, including only articles from the last 10 years. Results: A 6-year-old male patient with a history of bleeding during tooth extraction was transferred to a high-complexity hospital. He presented severe tricuspid insufficiency, cardiac dysfunction and hematologic decompensation, evolving with gangrene, anasarca, worsening of renal function and coagulation disorders. The patient was hospitalized with DIC and sepsis due to Staphylococcus aureus, resistant to penicillin, and was treated with antibiotics. Despite therapeutic measures such as fresh frozen plasma and cryoprecipitate, the clinical condition worsened, leading to amputation of the lower limbs and death one month after the second hospitalization. Conclusion: DIC is a critical complicating factor of sepsis, and the therapeutic approach should be individualized. The case highlights the difficulty in management given the scarcity of clinical studies, emphasizing the need for further research.
References
Goldman L, Ausiello D. Cecil: Tratado de Medicina Interna. 24ªEdição. Rio de Janeiro: Elsevier, 2015.
Levi M, Ten Cate H. Disseminated intravascular coagulation. N Engl J Med. 1999.
Taniguchi LU, et al. Sepsis-related deaths in Brazil: an analysis of the national mortality registry from 2002 to 2010. Crit Care. 2018; 18:608.
Silva E, Machado F. Sepse: conceito e epidemiologia. ILAS; 2016.
Levi M. Disseminated intravascular coagulation. Crit Care Med. 2007.
Toh CH, Alhamdi Y, Abrams ST. Current pathological and laboratory considerations in the diagnosis of disseminated intravascular coagulation. Ann Lab Med. 2016; 36:505.
Lawrence LKL. Clinical features, diagnosis, and treatment of disseminated intravascular coagulation in adults. Uptodate; 2017.
Bakhtiari K, Meijers JC, de Jonge E, et al. Prospective validation of the International Society of Thrombosis and Haemostasis scoring system for disseminated intravascular coagulation. Crit Care Med. 2004.
Dhainaut JF, Yan SB, Joyce DE, et al. Treatment effects of drotrecogin alfa (activated) in patients with severe sepsis with or without overt disseminated intravascular coagulation. J Thromb Haemost. 2004.
Gando S, Saitoh D, Ogura H, et al. Natural history of disseminated intravascular coagulation diagnosed based on the newly established diagnostic criteria for critically ill patients: results of a multicenter, prospective survey. Crit Care Med. 2008; 36:145.
Gando S. The utility of a diagnostic scoring system for disseminated intravascular coagulation. Crit Care Clin. 2012; 28:373-388.
Gando S, Saitoh D, Ogura H, et al. A multicenter, prospective validation study of the Japanese Association for Acute Medicine disseminated intravascular coagulation scoring system in patients with severe sepsis. Crit Care. 2013; 1:17.
Levi M, Toh CH, Thachil J, Watson HG. Diretrizes para o diagnóstico e manejo da coagulação intravascular disseminada. Comitê Britânico de Padrões em Hematologia. Br J Haematol. 2009.
Squizzato A, Hunt BJ, Kinasewitz GT, et al. Supportive management strategies for disseminated intravascular coagulation: an international consensus. Thromb Haemost. 2016; 115:896.
Levi M. Current understanding of disseminated intravascular coagulation. Br J Haematol. 2004; 124:567.
Bell GW, Joshi M, Macleod RI. A case of disseminated intravascular coagulation secondary to dental sepsis. Br Dent J. 2020;229(3):140–4.
Levi M, de Jonge E, van der Poll T, Ten Cate H. Disseminated intravascular coagulation. Thromb Haemost. 1999.
Levi M, Toh CH, Thachil J, Watson HG. Diretrizes para o diagnóstico e manejo da coagulação intravascular disseminada. Comitê Britânico de Padrões em Hematologia. 2009.
Müller MC, Meijers JC, Vroom MB, Juffermans NP. Utility of thromboelastography and/or thromboelastometry in adults with sepsis: a systematic review. Crit Care. 2014; 18
Wada H, Thachil J, Di Nisio M, Mathew P, Kurosawa S, Gando S, Kim HK, Nielsen JD, Dempfle CE, Levi M, Toh CH. Comitê de Normalização Científica sobre DIC da Sociedade Internacional de Trombose. Guia de Hemostasia para o diagnóstico e tratamento da DIC: harmonização das recomendações de três diretrizes. J Thromb Haemost. 2013.
Taylor JR, Toh CH, Hoots WK, Wada H, Levi M. Towards definition, clinical and laboratory criteria, and a scoring system for disseminated intravascular coagulation. Thromb Haemost. 2001.
Warren BL, Eid A, Singer P, et al. Cuidar do doente crítico. Alta dose de antitrombina III na sepse grave: um ensaio clínico randomizado e controlado. JAMA. 2001.
Cozinhas CS. Trombocitopenia e trombose em coagulação intravascular disseminada (DIC). Hematologia Programa Am Soc Hematol Educ. 2009.
Bernard GR, Vincent JL, Laterre PF, Larosa SP, Dhainaut JF. Efficacy and safety of recombinant human activated protein C for severe sepsis. N Engl J Med. 2001.
Matthay MA. Severe sepsis – a new treatment with both anticoagulant and anti-inflammatory properties. N Engl J Med. 2001.
