A case of idiopathic iliopsoas hemorrhage in an alcohol abuser effectively treated with vitamin K therapy

Abstract

A 48-year-old man presented with generalized fatigue and sudden bilateral blindness after continuous drinking without eating for about 3 weeks. He was transferred to our emergency center for suspected liver failure. He had an initial Glasgow Coma Scale of 11 and dilated pupil (7 mm) without light reflex. Laboratory data showed severe metabolic acidosis with elevated blood lactate. Although the acidosis and abnormal pupils were gradually improved by vitamin B administration and continuous hemodiafiltration treatment under mechanical ventilation, bleeding tendency became apparent, resulting in prolonged shock with progressing anemia. Abdominal CT (day 4) revealed an enlarged hematoma in the iliopsoas region. Hemorrhage continued despite platelet transfusion for thrombocytopenia. Menatetrenone (20 mg) administration immediately stopped the bleeding tendency and his prothrombin time increased from 56 to 99%. Subsequently, his circulatory dynamics stabilized and he was discharged on day 31 without complications. We speculated that the severe and rare iliopsoas hemorrhage was caused by coagulation disorder due to vitamin K deficiency from continuous drinking. When shock or progression of idiopathic anemia is observed in alcohol abusers, the possibility of bleeding from deep tissues (e.g., iliopsoas hemorrhage) should be considered keeping in mind the pathology associated with vitamin K deficiency.