A 71-year-old man with thrombocytopenia and hypotension after resection of a colonic carcinoma

Article Abstract:

A 71-year-old man who did not appear to be ill was admitted to the hospital after diagnostic tests indicated a tumor in the colon. The patient had no history of serious health problems, except for a history of mild diabetes and severe hypertension, which was controlled with medication. On the second day after his admission, a laparotomy was performed; exploration of the abdomen revealed a cancerous tumor of the colon that was removed. During surgery the patient suffered a myocardial infarction (heart attack) and a period of cardiac instability. In the post-operative period the patient's major symptoms included thrombocytopenia, (decrease in the number of blood platelets), hypotension (low blood pressure), and an insufficient supply of oxygen to body tissues. On day 15, treatment with heparin (which prevents blood clotting) was initiated when a deep venous thrombus (clot) in the left leg was diagnosed. By day 18, the patient experienced severe difficulty breathing. After additional tests were performed, it was concluded that the patient was suffering from heparin related adrenal hemorrhage, resulting in adrenal insufficiency (the adrenal glands produce hormones which influence many bodily functions). Rapid deterioration continued and after another heart attack and developing gangrene in the left leg, the patient died on the 32nd day of hospitalization. Autopsy results revealed adrenal hemorrhage with necrosis (tissue death) due to heparin-induced thrombocytopenia and other contributing factors. Coronary artery disease was also apparent, with three major arteries (that supply oxygen to the heart muscle) almost completely blocked. Other post mortem findings included severe thrombosis in the legs and lung disease.

Care and treatment, Abnormalities, Diagnosis, Causes of, Complications and side effects, Colorectal cancer, Hemorrhage, Thrombocytopenia, Thrombosis, Heparin, Adrenal glands, Southern, James F., Homcy, Charles J.

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A 59-year-old woman with a sore throat, fever, and polyarthralgia

Article Abstract:

Preceding hospital admission, a 59-year-old woman had episodes of fever, sore throat, extreme weakness, and temporary facial paralysis. Over the course of her hospital stay, a variety of symptoms, including joint pain, fluctuating temperatures, rash, heart murmur, anemia, and fatigue, were present. Her erythrocyte sedimentation rate (ESR), a blood test to detect inflammatory disease, was elevated. The groups of diseases considered for diagnosis were infection, cancer, granulomatous disorders (characterized by an excess of inflammatory cells), and connective tissue diseases. The final diagnosis was adult-onset Still's disease, also called juvenile rheumatoid arthritis. Symptoms were alleviated when drugs used to control inflammation were given. Six months later the medication was discontinued; symptoms did not recur one year after discharge from the hospital.

Case studies, Rheumatoid arthritis, column, Stafford-Brady, Frances J., Oldach, David W.

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