Beyond the Bruise: Unmasking Disseminated Intravascular Coagulation in Alcohol-Related Presentations

Disseminated intravascular coagulation (DIC) is a rare but life-threatening complication encountered in the emergency department (ED). It results from widespread activation of coagulation pathways, leading to simultaneous thrombosis and consumption of clotting factors, often culminating in severe bleeding and multi-organ failure. We report the case of a 39-year-old female with alcohol-related cirrhosis and autoimmune hepatitis who presented to the ED with a minor head injury and active bleeding from a groin ulcer. Her initial evaluation was confounded by alcohol intoxication and suspicion of domestic violence due to multiple bruises. Only after a delayed laboratory assessment was a diagnosis of DIC confirmed in the context of decompensated chronic liver disease with hepatic encephalopathy. She was treated with blood products and discharged with follow-up in the hepatology department. This case illustrates the diagnostic challenges of distinguishing trauma-related bruising from systemic coagulopathy in alcohol-related presentations. It emphasizes the importance of maintaining a high index of suspicion for DIC in cirrhotic patients, the role of the International Society on Thrombosis and Haemostasis DIC score, and the risks of diagnostic overshadowing in the ED. Early recognition and multidisciplinary intervention can significantly improve patient outcomes.