Consumption Coagulopathy in Miliary Tuberculosis

Abstract

A 56-year-old woman required hospitalization and endotracheal intubation because of progressive respiratory distress associated with bilateral diffuse pulmonary infiltrates. Within 12 hr she developed massive bleeding from a rectal hemorrhoid. Coagulation studies were consistent with a consumption coagulopathy. Despite heparin therapy the patient died. Postmortem examination showed that the immediate cause of death was an intracerebral hemorrhage. In addition there was extensive miliary tuberculosis with early granuloma formation. Histologic sections of the lung and kidney showed fibrin thrombi surrounding areas of caseation necrosis. Extensive fibrin thrombus formation in association with massive numbers of evolving tubercles is postulated as the cause of the consumption coagulopathy in this patient.