Case 1-2007 -- A 40-Year-Old Woman with Epistaxis, Hematemesis, and Altered Mental Status

doi:10.1056/NEJMcpc069032

Volume 356:174-182		January 11, 2007		Number 2

Case 1-2007 — A 40-Year-Old Woman with Epistaxis, Hematemesis, and Altered Mental Status

Michael Laposata, M.D., Ph.D., Elizabeth M. Van Cott, M.D., and Michael H. Lev, M.D.

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Presentation of Case

Dr. Amy Jo Chien (Medicine): A 40-year-old woman was admittedto the emergency department of this hospital because of thesudden onset of headache, loss of consciousness, and coagulopathy.

The patient had been in her usual state of good health untilapproximately 6 months earlier, when menorrhagia developed,with menstrual periods lasting for 2 weeks. Approximately 2weeks before admission to the emergency department of this hospital,she vomited blood clots after a meal. During the next severaldays, intermittent epistaxis, gingival bleeding, and easy bruisingoccurred. Eight days before admission to the emergency departmentof this hospital, she went . . . [Full Text of this Article]

Differential Diagnosis

Causes of Hemorrhagic Coagulopathy

Acquired Deficiency of Vitamin K–Dependent Coagulation Factors

Superwarfarin Pesticide Poisoning

Conclusions

Clinical Diagnosis

Dr. Michael Laposata's Diagnosis

Pathological Discussion

Pathological Diagnosis

Source Information

From the Departments of Pathology (M.L., E.M.V.) and Radiology (M.H.L.), Massachusetts General Hospital; and the Departments of Pathology (M.L., E.M.V.) and Radiology (M.H.L.), Harvard Medical School.