Disseminated intravascular coagulation with hyperfibrinolysis induced by a degenerating uterine leiomyoma: A rare case report
Disseminated intravascular coagulation (DIC) is typically associated with malignancy, sepsis, or obstetric complications. Its occurrence in benign tumors, particularly uterine leiomyomas, is extremely rare. We report a case of a 49-year-old woman with two months of menorrhagia. Laboratory tests revealed anemia, prolonged clotting times, hypofibrinogenemia, and markedly elevated D-dimer and fibrin degradation products (FDP) levels. Coagulation factor activities (V, VIII, XII) were reduced. Thrombin-antithrombin complex (TAT) and plasmin-α2-plasmin inhibitor complex (PIC) were elevated, and thromboelastography (TEG) indicated hypocoagulability with hyperfibrinolysis. Image revealed a large degenerating uterine fibroid. Comprehensive workup excluded autoimmune, neoplastic, and inherited causes. After perioperative antifibrinolytic and coagulation management, hysterectomy was performed. Pathology confirmed extensive intratumoral thrombosis. Coagulation parameters normalized postoperatively without requiring transfusion, and no thrombotic events were observed. This case highlights a rare but important cause of DIC with hyperfibrinolysis secondary to a benign uterine tumor. It underscores the value of TEG and molecular markers in diagnosis and management, and the need to consider benign tumors in the differential diagnosis of unexplained coagulopathy.