Question

A 50-year-old male, who is a meat-eater, recently completed a 2-week course of clindamycin. He now presents with hemarthroses and oozing at venipuncture sites. What is the most likely diagnosis?

1) Hemophilia A
2) Von Willebrand disease
3) Disseminated intravascular coagulation (DIC)
4) Idiopathic thrombocytopenic purpura (ITP)
5) Thrombotic thrombocytopenic purpura (TTP)

Answer 1

The most likely diagnosis for the described symptoms after a recent course of clindamycin is Disseminated intravascular coagulation (DIC), characterized by excessive clot formation and subsequent bleeding due to the consumption of clotting factors and platelets (3).

Step-by-step explanation:

The most likely diagnosis for a 50-year-old male who has recently completed a 2-week course of clindamycin and now presents with hemarthroses and oozing at venipuncture sites is Disseminated intravascular coagulation (DIC). DIC is a condition characterized by the widespread activation of the clotting cascade leading to the formation of blood clots in the small blood vessels throughout the body.

This excessive clotting consumes clotting factors and platelets, leading to bleeding tendencies due to the decreased availability of these critical components for hemostasis. Other potential diagnoses, such as Hemophilia A and Von Willebrand disease, are less likely given the acute presentation and recent antibiotic use. Hemophilia A and Von Willebrand disease are genetic disorders, which would likely have presented earlier in life. ITP and TTP are also possible considerations, but DIC is more consistent with the presentation of both thrombosis (clot formation) and hemorrhage (bleeding), particularly given the recent history of antibiotic use which can be a precipitating factor.