{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,21]],"date-time":"2026-08-21T10:24:23Z","timestamp":1787307863532,"version":"build-2736575974"},"reference-count":68,"publisher":"MDPI AG","issue":"16","license":[{"start":{"date-parts":[[2026,8,20]],"date-time":"2026-08-20T00:00:00Z","timestamp":1787184000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Int. J. Mol. Sci.","IJMS"],"abstract":"<jats:p>Infection-associated thromboinflammation may result from dysregulated interactions between innate immune activation, endothelial activation, and coagulation. Although influenza-like illnesses are generally self-limited in young individuals, severe respiratory infections have been associated with thrombo-inflammatory complications involving coagulation dysregulation and endothelial activation. We describe an 18-year-old previously healthy woman who developed extensive left iliofemoral deep vein thrombosis, bilateral pulmonary embolism, and progressive systemic venous and intracardiac thrombosis following an influenza-like illness. Despite therapeutic anticoagulation, the clinical course was complicated by acute compartment syndrome, progressive tissue ischemia, circulatory failure requiring vasopressor support, multiple organ dysfunction, and ultimately below-knee amputation. Laboratory investigations revealed thrombocytopenia, severe hypofibrinogenemia, markedly elevated D-dimer levels, reduced Protein C activity, and increased von Willebrand factor antigen (&gt;500%), consistent with overt disseminated intravascular coagulation and endothelial activation. A positive anti-PF4\/heparin immunoassay raised concern for heparin-induced thrombocytopenia; however, the subsequent clinical and laboratory evolution supported overt DIC as the predominant consumptive coagulopathy, while HIT could neither be confirmed nor definitively excluded. This case highlights a fulminant thrombo-inflammatory syndrome temporally preceded by an influenza-like illness of unconfirmed etiology and the diagnostic challenges posed by overlapping features of thrombotic-predominant overt disseminated intravascular coagulation and anti-PF4\/heparin antibody positivity.<\/jats:p>","DOI":"10.3390\/ijms27167456","type":"journal-article","created":{"date-parts":[[2026,8,20]],"date-time":"2026-08-20T12:57:53Z","timestamp":1787230673000},"page":"7456","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Fulminant Thromboinflammatory Syndrome Following an Influenza-like Illness in an Adolescent: Clinical Insights from a Case Report"],"prefix":"10.3390","volume":"27","author":[{"ORCID":"https:\/\/orcid.org\/0009-0007-6297-0378","authenticated-orcid":false,"given":"Mircea","family":"Stoian","sequence":"first","affiliation":[{"name":"Department of Anesthesiology and Intensive Care Medicine, George Emil Palade University of Medicine, Pharmacy, Science and Technology of T\u00e2rgu Mure\u0219, 540103 T\u00e2rgu Mure\u0219, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cristina Elena","family":"Garbovan","sequence":"additional","affiliation":[{"name":"Department of Infectious Diseases, George Emil Palade University of Medicine, Pharmacy, Science and Technology of T\u00e2rgu Mure\u0219, 540136 T\u00e2rgu Mure\u0219, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0007-4126-9339","authenticated-orcid":false,"given":"Sergio Rares Bandila","family":"Bandila","sequence":"additional","affiliation":[{"name":"Orthopedic Surgery and Traumatology Service, Marina Baixa Hospital, Avinguda Alcade En Jaume Botella Mayor, 03570 Villajoyosa, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3346-4082","authenticated-orcid":false,"given":"Attila","family":"Frigy","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine IV, George Emil Palade University of Medicine, Pharmacy, Science and Technology of T\u00e2rgu Mure\u0219, 540136 T\u00e2rgu Mure\u0219, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6862-4926","authenticated-orcid":false,"given":"Adina","family":"Stoian","sequence":"additional","affiliation":[{"name":"Department of Pathophysiology, George Emil Palade University of Medicine, Pharmacy, Science and Technology of T\u00e2rgu Mure\u0219, 540136 T\u00e2rgu Mure\u0219, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4004-9648","authenticated-orcid":false,"given":"Drago\u0219-Florin","family":"Bab\u0103","sequence":"additional","affiliation":[{"name":"Department of Cell and Molecular Biology, George Emil Palade University of Medicine, Pharmacy, Science and Technology of T\u00e2rgu Mure\u0219, 540142 T\u00e2rgu Mure\u0219, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mircea C\u0103t\u0103lin","family":"Co\u0219arc\u0103","sequence":"additional","affiliation":[{"name":"Department of Anatomy, George Emil Palade University of Medicine, Pharmacy, Science and Technology of T\u00e2rgu Mure\u0219, 540139 T\u00e2rgu Mure\u0219, Romania"},{"name":"Clinic of Vascular Surgery, Mure\u0219 County Emergency Clinical Hospital, 540136 T\u00e2rgu Mure\u0219, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3220-2267","authenticated-orcid":false,"given":"Leonard","family":"Azamfirei","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology and Intensive Care Medicine, George Emil Palade University of Medicine, Pharmacy, Science and Technology of T\u00e2rgu Mure\u0219, 540103 T\u00e2rgu Mure\u0219, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,8,20]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","unstructured":"Aklilu, A., Lai, M.S.-L., Jiang, Z., Yip, S.P., and Huang, C.-L. 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