Volumen: 6 # Number : 2
Publication Date : Mayo - Agosto Year: 2002
Authors: Paula Cardenas, Jorge Arbelbide, Elsa Nucifora, Juan Carlos Otaso, Luis Barrera
Abstract: Lonomia Ceterpillars are prevalent in Venezuela, Southern Brazil and Misiones Argentina. The venom in their bristles and haemolymph has several enzymes with procoagulant activity and they can induce haemorhage only by contact with the skin; in some cases without evident lesions. The poisoning with Lonomia Oblicua is also characterized by renal impairment but the etiology is not clarified. We present a 52 years old patient, presviously healthy. Five days before, she had been in a Park in Posadas (Misiones) and a few hours later presented vomits, diarrhoea, proctorrhage, haematuria, and spontaneous haematomas. The diagnosis of consumptive coagulopathy was made and she derived to our hospital. Upon admittance, she was conscious, with skin and mucous cavities bleeding, macroscopic haematuria and oligoanuria. Hematocrit 21.5%, platelets 27.700, Prothrombin activity 28%, APPT 56", fibrinogen 30mg/dl, urea 376 mg/dl, creatinine 12 mg/dl, FV 32%, FVII 70%, FVIII99%, FXIII 13%, FDP >160ug/ml, LDH 5.379 UI/L, and schistocytes in blood smear. The thromboelastogram showed a prolonged reaction time, a very prolonged open time 20mm with a pattern of hyperfibrinolysis. The diagnosis of renal impairment was made and haemodialysis was performed. A treatment with aprotinin was started when the coagulopaty with hyperfibrinolysis produced a several hypofibrinogenemia (30mg/dl). Fibrinogen raised to 120 mg/dl in 24 hours and she clinically improved. The values of fibrinogen remainded stable in spite showing a fibrinolytic pattern on the laboratory assays for several days. Histological analyses of the kidney biopsy showed actue tubular necrosis with mesangial proliferative glomerulitis and interestial mononuclear infiltration. She recived haemodialytic treatment fo 10 days with gradual recovery of diuresis and decrese of urea and creatinine to normal values in two months. The use of antifibrinolytic drugs such as aprotinin has proved to be useful to stop the fibrin hydrolysis and the activation of the coagulation system, decreasing the hemorrhagic complicatiosn, especially when the anti-venom is not available.
Key words: Lonomia , coagulopathy, renal failure
Pages : 36-41
|
