The secret behind profuse bleeding following a routine skin biopsy

A 73-year-old man underwent a facial skin biopsy, after which he experienced persistent, severe bleeding over a 4-day period that could not be staunched by suturing or cauterization. Patient history suggested a bleeding diathesis. A condition of chronic disseminated intravascular coagulation (DIC) that decompensated into an acute state of DIC subsequent to the biopsy was diagnosed based on laboratory findings. Physical examination followed by imaging revealed a large abdominal aortic aneurysm as the likely underlying etiology. The patient achieved stability with blood component replacement therapy and an initial round of heparin that was substituted with enoxaparin. Following cardiac catheterization, where triple vessel coronary artery disease was diagnosed, surgical correction of the abdominal aortic aneurysm and coronary artery bypass grafting were deemed to be too high risk. The patient was treated medically for his abdominal aortic aneurysm, coronary artery disease, and acute and chronic DIC. Within a year, the patient succumbed to a brainstem stroke. In patients with acute or chronic DIC, a thorough examination is recommended to exclude rare causes and to improve overall general management.