Fulminant disseminated intravascular coagulation following marsupialization of a Bartholin gland abscess: a case report

Bartholin gland abscess is a common gynecological condition usually managed with minimally invasive procedures and associated with a favorable prognosis. Severe systemic complications are rare. Disseminated intravascular coagulation is a life-threatening coagulopathy most commonly associated with sepsis and severe systemic inflammatory response. This report describes the case of a 20-year-old woman with no significant medical history who underwent marsupialization of a left-sided Bartholin gland abscess. The procedure was uncomplicated, and the initial postoperative course was unremarkable. Within 24 h, however, the patient developed sudden clinical deterioration with oliguria and petechial skin lesions, despite remaining afebrile and hemodynamically stable. Laboratory evaluation revealed thrombocytopenia, prolonged coagulation times, hypofibrinogenemia, markedly elevated D-dimer levels, and evidence of multiorgan dysfunction. Disseminated intravascular coagulation was diagnosed according to the International Society on Thrombosis and Haemostasis criteria. Blood cultures remained negative. The patient was managed with multidisciplinary care, broad-spectrum antibiotics, intensive supportive therapy, and blood product transfusions, resulting in gradual clinical and laboratory improvement. She was discharged without complications after 15 days of hospitalization. This case highlights that fulminant disseminated intravascular coagulation may develop after minor gynecological procedures performed in the setting of localized infection, even in the absence of documented sepsis or septic shock. Early recognition and prompt multidisciplinary management are essential to ensure favorable outcomes.