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Okubo A, Obata R, Azuma K, Kishimoto S, Mori M. Trousseau's Syndrome With Severe Visual Loss As the Initial Symptom. Cureus 2024; 16:e56211. [PMID: 38618326 PMCID: PMC11016198 DOI: 10.7759/cureus.56211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/10/2024] [Indexed: 04/16/2024] Open
Abstract
There are limited reports on patients with Trousseau syndrome, a condition characterized by hypercoagulability associated with malignant tumors, initially manifesting with reduced visual function. We present a case of a patient who experienced bilateral vision loss and was subsequently diagnosed with Trousseau's syndrome following examination and investigations. A 70-year-old man, undergoing chemotherapy for advanced pancreatic cancer, reported decreased visual acuity in both eyes. A dilated fundus examination revealed retinal pigment epithelial atrophy in the posterior pole and cotton-wool spots. Optical coherence tomography exhibited partial disruption of the ellipsoid zone in the parafoveal region, and full-field electroretinogram results were subnormal, although the macular retinal structure was preserved. Brain magnetic resonance imaging (MRI) detected occipital lobe infarction. Elevated coagulability markers, including D-dimer (5.5μg/mL), led to the diagnosis of Trousseau's syndrome. In cases where patients with malignant tumors present with profound visual loss, considering the possibility of Trousseau's syndrome and conducting assessments of brain function and coagulability is crucial for accurate diagnosis and appropriate management.
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Affiliation(s)
- Atsushi Okubo
- Ophthalmology, Saitama Red Cross Hospital, Saitama, JPN
| | - Ryo Obata
- Ophthalmology, University of Tokyo, Tokyo, JPN
| | - Keiko Azuma
- Ophthalmology, University of Tokyo, Tokyo, JPN
| | | | - Mikiro Mori
- Ophthalmology, Toranomon Hospital, Tokyo, JPN
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Zhao Z, Zhang J, Li N, Yao G, Zhao Y, Li S, Ge Q, Lu J, Bo S, Xi J, Han Y. Disseminated intravascular coagulation associated organ failure in obstetric patients admitted to intensive care units: a multicenter study in China. Sci Rep 2021; 11:16379. [PMID: 34385545 PMCID: PMC8360968 DOI: 10.1038/s41598-021-95841-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Accepted: 07/30/2021] [Indexed: 11/09/2022] Open
Abstract
We aimed to determine disseminated intravascular coagulation (DIC)-associated organ failure and underlying diseases based on data from three ICU wards in tertiary hospitals in China from 2008 to 2016. The diagnosis of DIC was confirmed by an International Society of Thrombosis and Hemostasis score greater than or equal to 5. The maternal outcomes included the changes in organ function 24 h after ICU admission. The durations of hospital stay and ICU stay were recorded as secondary outcomes. Among 297 ICU admissions (median Sequential Organ Failure Assessment score, 4) for obstetric diseases, there were 87 DIC cases, with an estimated DIC incidence of 87 per 87,580 deliveries. Postpartum hemorrhage was the leading disease associated with DIC (71, 81.6%), followed by hypertensive disorders (27, 31.0%), sepsis (15, 17.2%), acute fatty liver of pregnancy (11, 12.6%) and amniotic fluid embolism (10, 11.5%). Compared with patients without DIC, those with DIC had higher rates of multiple organ dysfunction syndrome/death (27.6% vs 4.8%, p = 0.000), organ failure (36.8% vs 24.3%, p = 0.029), among which organ failure included acute renal failure (32.2% vs 10.0%, p = 0.000), respiratory failure (16.1% vs 8.6%, p = 0.057), disturbance of consciousness (12.6% vs 2.4%, p = 0.000) and DIC group also had higher rates of massive transfusion (52.9% vs 21.9%, p = 0.000), hysterectomy (32.2% vs 15.7%, p = 0.001), longer ICU (4 days vs 2 days, p = 0.000) and hospital stays (14 days vs 11 days, p = 0.005). DIC and amniotic fluid embolism were independent risk factors for organ failure in patients admitted to the ICU. Postpartum hemorrhage was the leading cause of DIC associated organ failure in obstetrics admitted to the ICU. The control of obstetric bleeding in a timely manner may improve obstetric prognoses.
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Affiliation(s)
- Zhiling Zhao
- Department of Intensive Care Unit, Peking University Third Hospital, 49 North Garden Rd., Haidian District, Beijing, 100191, People's Republic of China
| | - Jianxin Zhang
- Department of Gynecology and Obstetrics, Capital Medical University Affiliated Beijing Chao-Yang Hospital, Beijing, China
| | - Nan Li
- Department of Research Center of Clinical Epidemiology, Peking University Third Hospital, Beijing, China
| | - Gaiqi Yao
- Department of Intensive Care Unit, Peking University Third Hospital, 49 North Garden Rd., Haidian District, Beijing, 100191, People's Republic of China.
| | - Yangyu Zhao
- Department of Gynecology and Obstetrics, Peking University Third Hospital, Beijing, China.
| | - Shuangling Li
- Department of Surgical Intensive Care Unit, Peking University First Hospital, Beijing, China
| | - Qinggang Ge
- Department of Intensive Care Unit, Peking University Third Hospital, 49 North Garden Rd., Haidian District, Beijing, 100191, People's Republic of China
| | - Junli Lu
- Department of Gynecology and Obstetrics, Capital Medical University Affiliated Beijing Chao-Yang Hospital, Beijing, China
| | - Shining Bo
- Department of Intensive Care Unit, Peking University Third Hospital, 49 North Garden Rd., Haidian District, Beijing, 100191, People's Republic of China
| | - Jingjing Xi
- Department of Intensive Care Unit, Peking University Third Hospital, 49 North Garden Rd., Haidian District, Beijing, 100191, People's Republic of China
| | - Yue Han
- Department of Intensive Care Unit, Capital Medical University Affiliated Beijing Chao-Yang Hospital, Beijing, China
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Pajor A, Hintalan A, Bakos L, Lintner F. Postpartum hemolytic uremic syndrome following placental abruption. Eur J Obstet Gynecol Reprod Biol 1993; 49:201-4. [PMID: 8405636 DOI: 10.1016/0028-2243(93)90271-d] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Hemolytic uremic syndrome associated with pregnancy is a rare condition. Authors report a patient treated with corticosteroids for bronchial asthma who was afflicted by placental abruption at 24 weeks' gestation. The abruption was preceded by developing herpes zoster and by deteriorating respiratory symptoms. The induced labor was followed by anuria, acute renal failure, microangiopathic hemolytic anemia, thrombocytopenia then fever and hypertension. The patient was treated early with plasma infusion, transfusion and hemodialysis. She recovered completely after 7 weeks. This case seems to be unique inasmuch as the hemolytic uremic syndrome was preceded by prodromal illness during pregnancy and was associated with placental abruption.
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Affiliation(s)
- A Pajor
- 2nd Department of Obstetrics and Gynecology, Semmelweis Medical University, Budapest, Hungary
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