Drug intoxication which was difficult to diagnose

Abstract

A 29-year-old woman was admitted to our hospital in an unconscious state. She presented with somnolentia and subcutaneous hemorrhage on the face, breast, arms, and legs. Laboratory examination revealed severe anemia and abnormal blood coagulation. Whole-body computed tomography revealed subdural hematoma and intra-abdominal bleeding. Blood was transfused and fresh frozen plasma and vitamin K were administered to treat the anemia and coagulopathy. Burr hole drainage was performed on the second day after the abnormal blood coagulation had improved. The patient was kept under observation due to the intra-abdominal bleeding for abdominal symptoms. The patient's mother informed us that a coumarin anticoagulant rodenticide was found in her room. The patient was subsequently diagnosed as suffering from intoxication induced by the abuse of a coumarin anticoagulant rodenticide. We then continued administering vitamin K, and the patient was discharged from our hospital on the 12th day after admission. Since the patient was unwilling to reveal her history, her condition could not be immediately diagnosed. We recognized the importance of patient history and vital data, including her lifestyle, in the diagnosis. Therefore, intoxication due to coumarin anticoagulant rodenticides should be considered when a patient presents with blood coagulation disorders or bleeding tendency.