A 66-year-old woman presented to an urgent care clinic for 2 to 3 weeks of general malaise, nausea/vomiting, night sweats, and dyspnea. On examination, she was tachycardic, and her laboratory evaluation was normal except for a lactate level of 4.4 mmol/L and platelet count of 118 × 109/L. CT imaging was performed. Two days later in the follow-up clinic, the patient's international normalized ratio (INR) was elevated, and she was hospitalized with initial findings of disseminated intravascular coagulation (DIC) (ie, INR > 10, platelets 97 × 109/L, fibrinogen < 60 mg/dL, positive D-dimer result). Bone marrow aspirate and peripheral blood smears were unrevealing. On day 4 of her hospitalization, the patient developed severe lactic acidosis (24 mmol/L) and hypoglycemia (11 mg/dL), and she was transferred to our institution. The patient had a history of a benign ovarian tumor, was a nonsmoker, did not drink alcohol, and was not taking any medications prior to admission. No ingestions or environmental exposures were noted.
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© 2016 American College of Chest Physicians