{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,22]],"date-time":"2026-01-22T00:27:36Z","timestamp":1769041656631,"version":"3.49.0"},"reference-count":34,"publisher":"BMJ","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Reports"],"accepted":{"date-parts":[[2014,9,28]]},"abstract":"<jats:p>We present a case of bilateral adrenal haemorrhage (BAH) associated with heparin-induced thrombocytopaenia (HIT) in a 61-year-old man admitted to hospital for the treatment of Fournier's gangrene. He presented to hospital with scrotal swelling and fever, and developed spreading erythaema and a gangrenous scrotum. His scrotum was surgically debrided and intravenous broad-spectrum antibiotics were administered. Unfractionated heparin was given postoperatively for venous thromboembolism prophylaxis. The patient deteriorated clinically 8\u201311\u2005days postoperatively with delirium, chest pain and severe hypertension followed by hypotension and thrombocytopaenia. Abdominal CT scan revealed bilateral adrenal haemorrhage. Antibodies to the heparin-platelet factor 4 complex were present. HIT-associated BAH was diagnosed and heparin was discontinued. Intravenous bivalirudin and hydrocortisone were started, with rapid improvement in clinical status. BAH is a rare complication of HIT and should be considered in the postoperative patient with unexplained clinical deterioration.<\/jats:p>","DOI":"10.1136\/bcr-2014-206070","type":"journal-article","created":{"date-parts":[[2014,10,14]],"date-time":"2014-10-14T10:44:08Z","timestamp":1413283448000},"page":"bcr2014206070","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":3,"title":["Bilateral adrenal haemorrhage associated with heparin-induced thrombocytopaenia during treatment of Fournier gangrene"],"prefix":"10.1136","volume":"2014","author":[{"given":"Timothy Lee","family":"Tattersall","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Isaac A","family":"Thangasamy","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jamie","family":"Reynolds","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2014,10,14]]},"reference":[{"key":"2025042706423488000_2014.oct14_1.bcr2014206070.1","doi-asserted-by":"publisher","DOI":"10.1007\/s10151-010-0592-1"},{"key":"2025042706423488000_2014.oct14_1.bcr2014206070.2","doi-asserted-by":"publisher","DOI":"10.1182\/asheducation-2013.1.668"},{"key":"2025042706423488000_2014.oct14_1.bcr2014206070.3","doi-asserted-by":"publisher","DOI":"10.1182\/blood-2005-04-1546"},{"key":"2025042706423488000_2014.oct14_1.bcr2014206070.4","doi-asserted-by":"crossref","first-page":"925","DOI":"10.1182\/blood.V72.3.925.bloodjournal723925","article-title":"Heparin-induced thrombocytopenia: laboratory studies","volume":"72","author":"Kelton","year":"1988","journal-title":"Blood"},{"key":"2025042706423488000_2014.oct14_1.bcr2014206070.5","doi-asserted-by":"publisher","DOI":"10.1097\/CCM.0b013e31820e6be4"},{"key":"2025042706423488000_2014.oct14_1.bcr2014206070.6","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(12)60409-7"},{"key":"2025042706423488000_2014.oct14_1.bcr2014206070.7","doi-asserted-by":"publisher","DOI":"10.1097\/CCM.0b013e318206d0eb"},{"key":"2025042706423488000_2014.oct14_1.bcr2014206070.8","doi-asserted-by":"publisher","DOI":"10.1016\/S0002-9343(96)00258-6"},{"key":"2025042706423488000_2014.oct14_1.bcr2014206070.9","doi-asserted-by":"publisher","DOI":"10.1160\/TH12-11-0865"},{"key":"2025042706423488000_2014.oct14_1.bcr2014206070.10","doi-asserted-by":"crossref","first-page":"132","DOI":"10.1160\/TH04-12-0825","article-title":"Clinical features of heparin-induced thrombocytopenia including risk factors for thrombosis. 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