Ocular involvement in disseminated intravascular coagulation (DIC)

Area of Science:

• Ophthalmology and Hematology
• Pathology of Thrombotic Disorders

Background:

• A 27-year-old woman presented with a complex constellation of symptoms including anorexia, abdominal pain, arthralgias, fever, diarrhea, and neurological disturbances.
• Initial clinical presentation suggested a systemic inflammatory or infectious process, necessitating a thorough diagnostic workup.

Observation:

• Ophthalmic examination revealed distinctive yellowish-gray plaques with surrounding hemorrhage in the posterior choroid of both eyes.
• Laboratory findings indicated progressive thrombocytopenia, hypofibrinoginemia, and accelerated fibrinolysis, strongly supporting disseminated intravascular coagulation (DIC).

Findings:

• Autopsy confirmed widespread thrombotic occlusion of small blood vessels across multiple organs.
• Specific findings included thrombotic events within the posterior choriocapillaris and larger choroidal vessels of both eyes.
• Ocular vessels, apart from those affected by thrombosis, appeared normal.

Implications:

• This case underscores the critical role of recognizing thrombotic microangiopathies, such as DIC, in patients with severe systemic illness and neurological symptoms.
• The ocular findings serve as a potential diagnostic marker for systemic thrombotic events, emphasizing the importance of comprehensive ophthalmologic evaluation.
• Understanding the vascular pathology in DIC is crucial for timely diagnosis and management to prevent catastrophic organ damage and mortality.