J Korean Med Sci.  2010 Sep;25(9):1372-1374. 10.3346/jkms.2010.25.9.1372.

Acute Kidney Injury due to Menstruation-related Disseminated Intravascular Coagulation in an Adenomyosis Patient: A Case Report

• Son J
• Lee DW
• Seong EY
• Song SH
• Lee SB
• Kang J
• Yang BY
• Lee SJ
• Choi JR
• Lee KS
• Kwak IS

• KMID: 1785920
• DOI: http://doi.org/10.3346/jkms.2010.25.9.1372

Abstract

The authors report a case of acute kidney injury (AKI) resulting from menstruation-related disseminated intravascular coagulation (DIC) in an adenomyosis patient. A 40-yr-old woman who had received gonadotropin for ovulation induction therapy presented with anuria and an elevated serum creatinine level. Her medical history showed primary infertility with diffuse adenomyosis. On admission, her pregnancy test was negative and her menstrual cycle had started 1 day previously. Laboratory data were consistent with DIC, and it was believed to be related to myometrial injury resulting from heavy intramyometrial menstrual flow. Gonadotropin is considered to play an important role in the development of fulminant DIC. This rare case suggests that physicians should be aware that gonadotropin may provoke fulminant DIC in women with adenomyosis.

Keyword

Kidney Failure; Multiple Organ Failure; Disseminated Intravascular Coagulation; Menstruation; Gonadotropins

MeSH Terms

Acute Kidney Injury/*diagnosis/etiology
Adult
Creatinine/blood
Disseminated Intravascular Coagulation/*chemically induced/complications
Endometriosis/*complications/diagnosis/surgery
Female
Fertilization in Vitro
Gonadotropins/*adverse effects
Humans
Magnetic Resonance Imaging
Menstruation/*physiology
Uterus/pathology/surgery

Figure

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  Fig. 1 T2-weighted MRI scan showing extensive adenomyosis involvement. Low signal intensity areas involving most of the uterus demonstrated diffuse thickening of the junctional zone. Punctuate high signal foci represent islands of ectopic endometrial tissue or microhemorrhage (arrows).

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  Fig. 2 Pathological findings of hysterectomized uterus. (A) Gross appearance of adenomyosis. Note coarsely trabeculated, diffusely hypertrophied myometrium stippled with foci of ectopic endometrium. (B) Hematoxylin and eosin-stained section of uterus, showing endometrial glands and stroma surrounded by hypertrophied myometrium. Occasional hemosiderin-laden macrophages were also observed. Magnification, ×100.

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