Bilateral adrenal haemorrhage associated with heparin-induced thrombocytopaenia during treatment of Fournier gangrene

Abstract

SUMMARYWe present a case of bilateral adrenal haemorrhage (BAH) associated with heparin-induced thrombocytopaenia (HIT) in a 61-year-old man admitted to hospital for the treatment of Fournier's gangrene. He presented to hospital with scrotal swelling and fever, and developed spreading erythaema and a gangrenous scrotum. His scrotum was surgically debrided and intravenous broad-spectrum antibiotics were administered. Unfractionated heparin was given postoperatively for venous thromboembolism prophylaxis. The patient deteriorated clinically 8-11 days postoperatively with delirium, chest pain and severe hypertension followed by hypotension and thrombocytopaenia. Abdominal CT scan revealed bilateral adrenal haemorrhage. Antibodies to the heparin-platelet factor 4 complex were present. HIT-associated BAH was diagnosed and heparin was discontinued. Intravenous bivalirudin and hydrocortisone were started, with rapid improvement in clinical status. BAH is a rare complication of HIT and should be considered in the postoperative patient with unexplained clinical deterioration. BACKGROUND

A rare case of intracerebral hemorrhage complicating heparin-induced thrombocytopenia in a COVID-19 patient

“…Hemorrhagic complications due to HIT are rare.Most of them are related with adrenal hemorrhage which is linked to adrenal vein thrombosis that is further complicated by arterial hemorrhage [ [8] , [9] , [10] , [11] ]and intra tumor hemorrhage [ 12 ].…”

Non-immune mediated thrombocytopenia caused by thromboprophylaxis for the perioperative care of urological surgery: A case report and review of the literature

“…A comprehensive MEDLINE search resulted in only 3 cases reports within the medical literature of HIT during urological surgery [8] , [11] , [12] . Consequently, urologists are not usually familiar with the management of and the principles for treating this condition.…”