Search

Liver cirrhosis and its complications constitute one of the most important causes of hospitalization in internal medicine departments. Liver cirrhosis is not a homogeneous disease entity, but is the final stage of many different liver diseases, and the most important causes leading to the development of liver cirrhosis are alcoholic liver disease and viral hepatitis. One of the typical complications of liver cirrhosis are symptoms of bleeding diathesis. The most common bleeding complication in patients with liver cirrhosis is bleeding from the upper gastrointestinal tract. The aim of this publication is to present a case report of a 32-year-old man in the terminal stage, hospitalized due to decompensated alcoholic cirrhosis of the liver, who during hospitalization developed a spontaneous large hematoma in the rectus abdominis muscle on the left side. The presented case report shows that in the care of patients with decompensated liver cirrhosis, vigilance must be maintained to recognize bleeding complications, including those with an atypical clinical course.

Introduction: Scurvy has become a rare disease in western countries with potentially high morbidity. Early diagnosis is crucial and can be challenging. Case Presentation: We present the case of a 56-year-old male patient who developed hemorrhagic diathesis after trivial impact trauma. Previously, the patient suffered from fatigue and loss of appetite. Characteristic skin eruptions and a distinct skin histology along with a decreased serum vitamin C level led to the diagnosis of scurvy. Following vitamin C supplementation, symptoms improved rapidly. Conclusion: In conclusion, vitamin C deficiency should be considered in cases with unclear hemorrhagic diathesis and a medical history of nutritional irregularities. Especially in cases of scurvy that do not yet show the full clinical spectrum of symptoms or have only moderately decreased serum vitamin C levels, thorough clinical dermatological examination and a skin biopsy are essential for early diagnosis and to prevent complications.

Copyright of Annales Academiae Medicae Silesiensis is the property of Medical University of Silesia and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Introduction: Scurvy has become a rare disease in western countries with potentially high morbidity. Early diagnosis is crucial and can be challenging. Case Presentation: We present the case of a 56-year-old male patient who developed hemorrhagic diathesis after trivial impact trauma. Previously, the patient suffered from fatigue and loss of appetite. Characteristic skin eruptions and a distinct skin histology along with a decreased serum vitamin C level led to the diagnosis of scurvy. Following vitamin C supplementation, symptoms improved rapidly. Conclusion: In conclusion, vitamin C deficiency should be considered in cases with unclear hemorrhagic diathesis and a medical history of nutritional irregularities. Especially in cases of scurvy that do not yet show the full clinical spectrum of symptoms or have only moderately decreased serum vitamin C levels, thorough clinical dermatological examination and a skin biopsy are essential for early diagnosis and to prevent complications. [ABSTRACT FROM AUTHOR]

Camels are adapted to digestion of dry rough forages for their nutrition, and sudden change to highly digestible feed during the racing season causes digestive disorders. The current study investigated the cause of death among racing dromedary camels within 3–7 days following a sudden onset of fever ≈ 41 °C, colic with tarry feces, and enlarged superficial lymph nodes. Marked leukopenia, low RBC count and thrombocytopenia, deranged liver and renal function tests, and prolonged coagulation profiles were reported. Compartment 1 fluid revealed a pH of 4.3–5.2 with absence or few ciliated protozoa and Gram-positive microbial flora. Widespread petechial to ecchymotic hemorrhages were observed in various organs including the gastrointestinal tract (compartment 3 and colon), lungs, and heart. Fibrin thrombi in arterioles, capillaries, venules, and medium-sized veins were observed especially in the pulmonary interstitium, submucosa of the large intestine (ascending colon), deep dermis, and renal cortex. Furthermore, widespread hemorrhages and necrosis were constant histopathological lesions in parenchymatous organs. Based on clinical signs, hematology, blood biochemistry, and gross and microscopical findings, the cases were diagnosed as compartment 1 acidosis associated with hemorrhagic diathesis and endotoxicosis. Finally, compartment 1 acidosis associated with hemorrhagic diathesis is a serious fatal disease on the Arabian Peninsula in racing dromedaries causing multi-organ dysfunction and coagulopathy and disseminated hemorrhages. [ABSTRACT FROM AUTHOR]

Copyright of Universitas Médica is the property of Pontificia Universidad Javeriana and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Journal of Transfusion Medicine is the property of VM Medica-VM Group (Via Medica) and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Dammar resin is a natural food additive and flavoring substance present in many foods and drinks. The present study evaluates the chronic toxicity and carcinogenicity of dietary dammar resin in F344 rats. Dietary concentrations in the 52-week chronic toxicity study were 0, 0.03, 0.125, 0.5, or 2%. The major treatment-related deleterious effects were body weight suppression, increased relative liver weight, and low hemoglobin levels in males and females. Foci of cellular alteration in the liver were observed in the male 2% group, but not in any other group. The no-observed-adverse-effect level for chronic toxicity was 0.125% for males (200.4 mg/kg b.w./day) and females (241.9 mg/kg b.w./day). Dietary concentrations in the 104-week carcinogenicity study were 0, 0.03, 0.5, or 2%. Dammar resin induced hemorrhagic diathesis in males and females, possibly via the inhibition of extrinsic and intrinsic coagulation pathways. Incidences of hepatocellular adenomas and carcinomas were significantly increased in the male 2% group, but not in any other group. In the 4-week subacute toxicity study, the livers of male rat-fed diet-containing 2% dammar resin had increased levels of protein oxidation and increased the expression of two anti-apoptotic and seven cytochrome P450 (CYP) genes. There was also an increased tendency of oxidative DNA damage. These findings demonstrate that dammar resin is hepatocarcinogenic in male F344 rats and underlines the roles of inhibition of apoptosis, induction of CYP enzymes, and oxidative stress in dammar resin-induced hepatocarcinogenesis. [ABSTRACT FROM AUTHOR]

The aim of this case report is to present the life saving use of extracorporeal membrane oxygenation (ECMO) in an obstetric patient with acute cardiorespiratory collapse following massive bleeding caused by an atonic uterus post partum. A 39-year-old patient, following a spontaneous abortion at 21 weeks of pregnancy, developed uterine atony and massive bleeding and was ultimately referred to the operating room for an emergent hysterectomy. Postoperatively, she was referred to the intensive care unit (ICU) where she developed severe acute respiratory distress syndrome (ARDS) that was successfully treated by employing ECMO. Following discontinuation of ECMO, her treatment was further complicated by a manifest hemolytic transfusion reaction. Although extensive testing was done to establish the cause of this reaction, we were unable to find it. The patient responded well to treatment with erythropoietin (EPO) and corticosteroids as well as a restrictive transfusion regime. This treatment pointed to a possible immune reaction to massive transfusions of blood products. This case demonstrated the importance of early aggressive treatment using ECMO in reversal of life threatening ARDS, as well as the need for a judicious approach when transfusing blood products. [ABSTRACT FROM AUTHOR]

Dengue is an acute viral illness caused by RNA virus of the family Flaviviridae and spread by Aedes mosquitoes. Presenting features may range from asymptomatic fever to dreaded complications such as hemorrhagic fever and shock. A cute-onset high fever, muscle and joint pain, myalgia, cutaneous rash, hemorrhagic episodes, and circulatory shock are the commonly seen symptoms. Oral manifestations are rare in dengue infection; however, some cases may have oral features as the only presenting manifestation. Early and accurate diagnosis is critical to reduce mortality. Although dengue virus infections are usually self-limiting, dengue infection has come up as a public health challenge in the tropical and subtropical nations. This article provide a detailed overview on dengue virus infections, varied clinical manifestations, diagnosis, differential diagnosis, and prevention and treatment. [ABSTRACT FROM AUTHOR]

Copyright of Ginecología y Obstetricia de México is the property of Federacion Mexicana de Ginecologia y Obstetricia and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

A 4-week-old infant presented with a coagulation disorder resulting from a vitamin K deficiency. The vitamin K deficiency was caused by neonatal cholestasis due to biliary atresia. Jaundice, hepatomegaly and pale stools are the predominant presenting symptoms of biliary atresia, none of which were recognized in our patient before admission. However, the patient presented with bleeding caused by vitamin K deficiency. She was fully breastfed and had received adequate doses of vitamin K at birth and from the age of 1 week. In case of a hemorrhagic diathesis due to neonatal cholestasis, timely identification of treatable underlying disorders, in particular biliary atresia, is important because an early surgical intervention results in a better prognosis. Meticulous history taking and a thorough physical exam can be decisive for an early diagnosis and subsequent intervention. [ABSTRACT FROM AUTHOR]

Introduction: Hermansky-Pudlak syndrome is an autosomal recessive multisystem disease characterized by oculocutaneous albinism, hemorrhagic diathesis and pulmonary fibrosis in some subtypes. Rare disease that occurs in 1 in 1,000,000 individuals worldwide. Deficiency of the platelet storage pool is associated with a lack of dense bodies in platelets, with an impaired response in the secondary phase of aggregation. Patients with HPS have normal clotting tests, however their bleeding time is prolonged despite normal or increased platelet counts Objectives: To describe a complication resulting from a rare genetic syndrome in the postoperative period of nasal surgery. Resumed report: Patient, 26 years old, with albinism and spontaneous nystagmus, underwent septoplasty and inferior turbinectomy bilaterally in June 2021 due nasal obstruction refractory to clinic treatment. Coagulogram, hemogram and other laboratory tests preoperative were normal. Intraoperative patient has had an usual bleeding, difficult hemostasis and recurrent epistaxis in the outpatient visits. Outpatient visits in July 2021, patient has had spontaneous epistaxis bilaterally. Anterior packing was performed, but not failed on hemostasis. Nose Bleeding stopped just after platelet transfusion. Blood tests showed dysfunctional platelet aggregation test with epinephrine and hypoagglutination with ristocetin at high concentration. This alteration was responsive to administration os 50% of platelet-poor plasma. A hypothesis of platelet pool disease was discussed, with hematologic clinic physician: the main hypothesis was Hermansky-Pudlak Syndrome. Conclusion: This is a diagnosis to be considered in patients with albinism, associated with nystagmus and better preoperative planning and postoperative care should be performed. [ABSTRACT FROM AUTHOR]

The present study has intended to contribute to the elucidation of the pathogenic mechanisms, involved in the thrombocytopenia and in the bleeding diathesis seen in the course of Leptospirosis. The group of cases included in the present prospective study consisted of 30 patients with Leptospirosis, admitted to the Infectious and Parasitic Diseases Ward, Hospital das Clínicas, Faculty of Medicine, University of São Paulo. The following possible mechanisms of thrombocytopenia have been considered and therefore investigated: platelet consumption, due to disseminated intravascular coagulation; immune-mediated platelet destruction, due to platelet-associated antibodies and an inhibited platelet production in the bone marrow. Thrombocytopenia occurred in 86.6% of 30 patients and did not seem to be immune-mediated by platelet-associated antibodies. Furthermore it did not seem to be due to a disseminated intravascular coagulation consumption. Although there was a statistically-significant correlation between bone marrow platelet production and platelet counts we think that the static microscopic examination of a bone marrow aspirate cannot accurately depict the dynamic mechanisms of platelet production when these cells are being consumed in peripheral blood. Vasculitis should be considered as the most important factor for the pathogenesis of the bleeding disturbances in Leptospirosis. However, we believe that thrombocytopenia, uremia and coagulation disorders, individually or as a group, should be included among the contributing factors that lead to and worsen bleeding episodes, which represent the leading cause of death in this disease.O propósito do presente trabalho é colaborar para o estudo da patogenia da plaquetopenia que ocorre na Leptospirose. A pesquisa foi feita de maneira prospectiva e o grupo de casos foi constituído por 30 pacientes internados com hipótese diagnostica de Leptospirose na Clínica de Doenças Infecciosas e Parasitárias do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo. Investigou-se a possibilidade de haver consumo de plaquetas por coagulação intravascular disseminada, ou a possibilidade de destruição periférica de plaquetas por anticorpos e, se poderia haver inibição da produção de plaquetas em nível medular. Para a investigação desejada foram utilizados os seguintes exames: contagem de plaquetas, tempo de protrombina, tempo de recalcificação, tempo de trombina, tempo de tromboplastia parcial ativada, dosagem do fibrinogênio, dosagem do fator V, dosagem do fator VIII, dosagem dos produtos de degradação da fibrina, dosagem da antitrombina III, mielograma e pesquisa de anticorpos antiplaquetas. Foram ainda estudados o hemograma, a dosagem de uréia, a dosagem de creatinina, a dosagem das enzimas hepáticas (aspartatoaminotransferase, alaninaaminotransferase, desidrogenase láctica, gamaglutamiltranspeptidade e fosfatase alcalina), e a dosagem das bilirrubinas. A análise dos dados obtidos no presente trabalho permitiu-se chegar às seguintes constatações e conclusões: 1ª) A plaquetopenia é freqüentemente encontrada na forma grave de Leptospirose ocorrida em nosso meio (86,6%). 2ª) A plaquetopenia da Leptospirose não parece ser mediada por anticorpos antiplaquetas. 3ª) A avaliação dos dados obtidos não mostrou haver evidências clínicas e laboratoriais de ocorrência de coagulação intravascular disseminada. 4ª) Verificou-se existência da relação de dependência entre a plaquetogênese medular e a contagem de plaquetas no sangue periférico (P = 0,0261). A possibilidade de haver inibição da plaquetogênese medular por algum produto bacteriano (toxina) não pode ser totalmente afastada, porém acreditamos que o exame estático da medula óssea não pode dar-nos uma idéia precisa do mecanismo dinâmico da formação de plaquetas na presença de "consumo periférico". 5ª) Embora a plaquetopenia possa representar um fator contribuinte para a síndrome hemorrágica, não chegamos a uma diferença estatisticamente significativa entre a contagem das plaquetas nos pacientes plaquetopênicos que sangraram e nos que não apresentaram sangramento. 6ª) Na maioria dos casos (86,3%) a normalização da contagem das plaquetas ocorreu no período de sete dias após a internação. 7ª) Não houve diferença significativa entre as médias dos tempos de normalização da contagem de plaquetas nos pacientes que apresentaram e nos que não apresentaram sangramento. 8ª) Houve diferença significativa, entre as médias das contagens das plaquetas nos pacientes de níveis séricos menores e os níveis séricos mais elevados de uréia, sendo maior no primeiro grupo (t22 = 1,818 > t22:0.05 = 1,717). 9ª) A média do nível sérico dos pacientes que apresentaram sangramento foi maior do que a média do nível sérico de uréia dos pacientes que não sangraram, podendo-se afirmar que a uremia contribui para agravar o quadro hemorrágico na Leptospirose. A vasculite deve ser considerada como fator mais importante na patogênese dos distúrbios hemorrágicos da Leptospirose1,2,8,23, porém, acreditamos que a trombocitopenia, a uremia e os distúrbios da coagulação, isoladamente ou em conjunto, devem ser incluídos entre os fatores que agravam o quadro hemorrágico o qual representa hoje a principal causa de óbito na doença.

Dental surgery in patients with hemorrhagic diathesis represents a great clinical challenge regarding the bleeding and complicated infections. There are various methods and materials for haemostasis of these patients. One of them is ABS (Ankaferd Blood Stopper), which has been approved for the clinical management of external post-surgical and dental surgery bleedings in Turkey. ABS could be effectively used both in individuals with normal haemostatic parameters and in patients with deficient primary hemostasis and/or secondary hemostasis. In this case series, total 11 patients who have various illnesses especially hemorrhagic diathesis are presented. ABS application demonstrated successful clinical management of the patients with various types of hemorrhagic diathesis. [ABSTRACT FROM AUTHOR]

Copyright of Der Ophthalmologe is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Ankaferd is a folkloric medicinal plant extract which has historically been used as an hemostatic agent in traditional Turkish medicine. Ankaferd Hemostat (ABS, Ankaferd BloodStopper®) includes the plants of Thymus vulgaris, Glycyrrhiza glabra, Vitis vinifera, Alpinia officinarum and Urtica dioica. The hemostatic effects of ABS have been established in the in vitro and in vivo studies in the Literature. The basic mechanism of action for ABS is the formation of an encapsulated protein network representing the focal points for the vital erythroid aggregation. The topical usage of ABS as a hemostatic agent in clinical hemorrhages and during dental interventions provided the first clues about the safety and efficacy of ABS in humans. The aim of this study is to search topical safety of ABS in a phase I randomized, double-blinded, cross-over, placebo controlled clinical study in healthy volunteers. Twenty-four healthy volunteers (11 males and 13 females, aged 18-44 years) compatible with the study protocol were enrolled into the study. In this study, topical ABS application for 120 minutes is not different from the placebo, in terms of both the local skin findings and systemic laboratory tests. Based on those data, it is concluded that topical application of ABS is safe and tolerable in humans. [ABSTRACT FROM AUTHOR]

Abstract: Sustaining hemostasis in clinical hemorrhages is a challenging task and requires extensive effort to stabilize medically hard-to-treat traumatic injuries. Several hemostatic agents are preferred to control external and internal bleedings, yet commercially available products are not sufficiently effective or fast-acting to achieve hemostasis in extreme cases. Ankaferd Blood Stopper (ABS) is a herbal extract traditionally used as a hemostatic agent. Recent studies have shown that ABS could be utilized successfully as a hemostatic agent for the management of clinical hemorrhages when conventional methods were ineffective. This review serves as a basis to provide recent findings on several applications of ABS, specifically preclinical, biological, and clinical studies both in vitro and in vivo. Another section focuses on the ultrastructural morphology and protein network formation of ABS in an effort to understand the hemostatic mechanisms of this unique agent at tissue level. [Copyright &y& Elsevier]

A pregnant woman was diagnosed with acute promyelocytic leukemia at 38 weeks of gestation. Induction of labor was successful, and the patient delivered a healthy male baby. Soon after delivery, she was treated with chemotherapy using all-trans-retinoic acid (ATRA). The number of white blood cells was increased on the fifth postpartum day and retinoic acid syndrome (RAS) was considered a concern. On the sixth postpartum day, remission induction chemotherapy with idarubicin and cytosine arabinoside was started. On the seventh postpartum day, massive uterine bleeding of more than 1300 mL suddenly occurred. As administration of cytotoxic agents may induce disseminated intravascular coagulation, we should take care to avoid uterine bleeding after chemotherapy in acute promyelocytic leukemia cases treated soon after delivery. [ABSTRACT FROM AUTHOR]

Ankaferd BloodStopper® (ABS) is an herbal extract which has been used historically as a haemostatic agent in traditional Turkish medicine. ABS comprises of standardized mixture of herbs Thymus vulgaris, Glycyrrhiza glabra, Vitis vinifera, Alpinia officinarum and Urtica dioica. Basic effect mechanism of ABS is the formation of an encapsulated protein web which represents the focus points for the vital erythrocyte masses. The haemostatic effects have been demonstrated by in vitro and in vivo studies. The usage of ABS as a hemostatic agent in external hemorrhages and in dental treatment in humans constitutes the first hints on ABS's safety and efficacy in humans. A phase I randomized, double-blinded, cross-over, placebo controlled clinical study in healthy volunteers indicated the safety of ABS. The aim of this report is to depict hemostatic effects of ABS in critical bleedings due to hemorrhagic diathesis, refractory to conventional measures in distinct clinical settings. [ABSTRACT FROM AUTHOR]

Glanzmann thrombasthenia is an autosomal and recessively inherited disorder resulting from abnormality in the first step of thrombosis. In cases associated with hemorrhagic diathesis and ecchymotic mucocutaneous lesions, Glanzmann thrombasthenia should be taken into account in differential diagnosis if thrombocyte count is normal and bleeding duration is too long. In this study, we present the case of a pair of twins in which one of the siblings was lost in the uterus while the other had sepsis along with common intravascular coagulopathy and was eventually diagnosed with Glanzmann thrombasthenia. [ABSTRACT FROM AUTHOR]

Copyright of Medizinische Klinik (Urban & Vogel) is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

A 68-year-old woman presented with profuse hemorrhage and other signs suggesting an acute leukemia. Histologic and cytogenetic evaluation of her bone marrow revealed alveolar rhabdomyosarcoma as the underlying cause of massive disseminated intravascular coagulation and hyperfibrinolysis. A review of the literature reveals that coagulopathy appears to be a common feature of alveolar rhabdomyosarcoma. [ABSTRACT FROM AUTHOR]

Copyright of Gefaesschirurgie is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

This paper presents a study of treatment involving vitamin K (VK) accompanied by bile acids for hemorrhagic diathesis that was applied 42 times in 35 patients with decompensated liver cirrhosis. The hepaplastin test (HPT) value showed no change during the administration of VK alone. The HPT value elevated significantly, however, after the administration of VK with bile acid, expecially when using ursodeoxycholic acid (UDCA). The HPT value in patients treated with VK in addition to UDCA before treatment with 53.2% ± 10.2% (mean ± SD) and after that for 2.1 ± 1.1 months (mean ± SD) with 74.7 ± 16.8% showed a significant difference (p< 0.001). On the other hand, no significant difference was noted between the HPT value of 57.2 ± 13.6% before and that of 62.9 ± 13.9% after the treatment in patients treated using VK in conjunction with chenodeoxycholic acid (CDCA). These results indicate that the therapy incorporating VK and bile acid, especially UDCA, is useful for reducing the hemorrhagic tendency in patients with decompensated liver cirrhosis who show no improvement using VK alone. [ABSTRACT FROM AUTHOR]

Recently it has been paid attention whether the liver diseases might induce the disseminated intravascular coagulation (DIC) or not, although it has well known that liver cirrhosis contribute to the hemorrhagic diathesis. In this paper, we studied on the hemorrhagic tendency and hemostatic tests in the patients with liver cirrhosis in order to clarify the coagulation and fibrinolytic activity. We can conclude that the hemorrhagic diathesis occurs due to the complex of decreases in platelet number, platelet functions, clotting factors, and increased fibrinolytic activity. The increased fibrinolytic activity may be primary and the frequency of clinically important DIC is quite low. [ABSTRACT FROM AUTHOR]

Background: We aimed to examine cases of brucellosis that presented with severe thrombocytopenia and hemorrhagic diathesis. Methods: A total of 10 brucellosis cases with severe thrombocytopenia were included in this case-series study. Patients' files were reviewed for their clinical and laboratory findings, as well as clinical outcomes and complications. Platelet counts of < 20000/mm3 were diagnosed as severe thrombocytopenia. Results: The lowest thrombocyte count was 3000/mm3 while the highest was 19000/mm3 (mean: 12000/mm3). Patients had the following symptoms: epistaxis (7 cases), petechia with epistaxis (4 cases), bleeding gums (3 cases), ecchymosis with epistaxis (2 cases), melena and renal failure (2 cases), and hematuria (1 case). Patients were given rifampicin and doxycycline along with supportive hematological therapy. All were treated successfully with no evidence of recurrence at follow-up visits. Conclusion: Since brucellosis is endemic in developing countries, it must be considered in the differential diagnosis of cases that present with severe thrombocytopenia and hemorrhagic diathesis. [ABSTRACT FROM AUTHOR]

We present an unusual case of a drug-related hemorrhagic diathesis. One month prior to admission, the patient was diagnosed at another medical center as having Graves' disease and propylthiouracil therapy (PTU) was initiated. Since clinical recovery was not achieved, the PTU was quickly increased to an unconventional daily dose of 1,000 mg. The patient was referred to our hospital because of spontaneous epistaxis, multiple ecchymoses and prolonged prothrombin time (PT) and activated partial thromboplastin time (aPTT), which developed soon after the increase in PTU dose. Drug-related hemorrhagic diathesis was considered, after other possible causes had been eliminated. To the best of our knowledge, this is the first reported case of spontaneous hemorrhage due to PTU use. [ABSTRACT FROM AUTHOR]