Do not ignore Walzel’s sign with Acut Severe Pancreatititis: A Mortal Chain of Complications with Multiple Organ Dysfunction Syndrome and Disseminated Intravascular Coagulation

Abstract

Introduction: This case report describes a patient with severe acute pancreatitis (AP) who presented with livedo reticularis (Walzel's sign), a rare cutaneous finding. Case report: A 51-year-old woman presented to the emergency department with reticular skin lesions starting from the lower extremities and spreading throughout the body. Laboratory and radiologic investigations showed that she developed severe AP, multiple organ failure and disseminated intravascular coagulation. The patient's clinical course deteriorated rapidly and he died in cardiac arrest within approximately 10 hours. Conclusion: This case is presented to contribute to the literature and to point out that Walzel's sign characterized by livedo reticularis, a rare skin finding in severe AP, may be a clinical sign that may lead to early diagnosis. It is envisioned that early diagnosis in patients with severe AP with aggressive course may have a favorable effect on the clinical course and prognosis.

Keywords

• Acute pancreatitis
• Livedo reticularis
• Walzel’s sign
• Acute renal failure
• Disseminated intravascular coagulation

Akut Şiddetli Pankreatitte Walzel belirtisini göz ardı etmeyin: Çoklu Organ Disfonksiyonu Sendromu ve Yaygın Damar İçi Pıhtılaşma ile Ölümcül Bir Komplikasyon Zinciri

Abstract

Giriş: Bu vaka sunumu, nadir bir deri bulgusu olan livedo retikülaris (Walzel belirtisi) ile başvuran şiddetli akut pankreatitli (AP) bir hastayı ele almaktadır. Vaka sunumu: 51 yaşındaki kadın hasta, acil servise alt ekstremitelerden başlayıp tüm vücuda yayılan retiküler formda cilt lezyonları ile başvurmuştur. Laboratuvar ve radyolojik incelemeler, hastada şiddetli AP, çoklu organ yetmezliği ve dissemine intravasküler koagülasyon geliştiğini göstermiştir. Hastanın klinik seyri hızlı bir şekilde kötüleşmiş ve yaklaşık 10 saat içinde kardiyak arrest sonucu kaybedilmiştir. Sonuç: Bu vaka şiddetli AP'de nadir görülen cilt bulgusu olan livedo retikülaris ile karakterize Walzel’s işaretinin erken tanıya götürebilecek klinik bir işaret olabileceğine dikkat çekmek ve literatüre katkıda bulunmak için sunulmuştur. Agresif seyirli şiddetli AP hastalarında erken tanı konulmasının klinik seyri ve prognozu olumlu yönde değiştirebilecek bir etki oluşturabileceği öngörülmüştür.

Keywords

• Akut pankreatit
• Livedo retikülaris
• Walzel belirtisi
• Akut böbrek yetmezliği
• Dissemine intravasküler koagülasyon.

References

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