Liver infarction in a patient with Clostridium

Patients with acute leukemia are prone to develop infections with various microorganisms, including Clostridium difficile (CD). The evolution and complications of colitis with CD in these patients are far from being fully known and understood. A 66-year-old female patient was diagnosed with an acute B-lymphoblastic leukemia. A central venous catheter placed in the left femoral vein was complicated with venous thrombosis. Anticoagulant treatment was given until the onset of medullary aplasia. The chemotherapy consisted of the HYPER-C VAD/ MTX/ARA-C protocol (cyclophosphamide, vincristine, doxorubicin and dexamethasone followed by methotrexate and cytarabine). After the first cycle of chemotherapy, 35-65% blast cells remained in the bone marrow. One week after the second chemotherapy cycle, the patient developed a CD colitis, which was treated with vancomycin, orally. The patient had no blast cells in the peripheral blood when the bone marrow started to recover from the post-chemotherapy aplasia and started the prophylactic treatment with dalteparin 5000UI/ day, s.c. when the number of platelets increased over 30,000/ mm3. She suddently presented increased aminotransferase levels (up to 7217 U/L) and total serum bilirubin level (up to 2.95 mg/dl). Acute viral hepatitis A, B and E were excluded. Blood fibrinogen, fibrin monomers and D-dimers levels were increased. An angio-computed tomography (CT) detected an obstruction of the right branch of the portal vein and a large hypofixant area into the right liver lobe (Fig. 1), suggestive of liver infarction. Evolution of the patient was unfavorable: she developed severe liver failure followed by death. Conventional clotting tests often offer abnormal results in patients with acute lymphoblastic leukemia, suggesting a bleeding tendency when, in fact, thrombosis is a higher risk [1]. Global clotting tests provide the results of the effect and interaction of multiple pathways and are superior to conventional clotting tests for the exploration of coagulation: LETTERS TO THE EDITOR