Abstract
Acquired factor XIII (FXIII) deficiency can result in life-long bleeding tendency and can be caused by enhanced consumption, impaired synthesis, or as an immune-mediated process. The latter can be related with solid neoplasms, through neutralizing or non-neutralizing antibodies. The relationship between FXIII activity and non-small cell lung cancer (NSCLC) is not well established. This case report is about a patient with NSCLC and acquired FXIII deficiency. Materials and Methods: Clinical records were obtained through the electronic process analysis, and the confidentiality of the patient was always assured. Results and Discussion: A 70-year-old male with no relevant past medical history and a recently diagnosed metastatic NSCLC was admitted for priapism. Five days later, a he developed a bleeding disorder, with slightly elevated coagulation times and normal fibrinogen levels and platelets count. FXIII level was found to be decreased (0.24 IU/mL) and FXIII plasma mixing studies did not confirm the presence of a neutralizing inhibitor. The FXIII level correction with standard plasma mixing studies was in favour of a non-neutralizing antibody. Despite treatment, haemorrhage control was not achieved and the patient died. Conclusion: This clinical report describes a rare case of a patient with metastatic NSCLC presenting a severe haemorrhagic event caused by FXIII deficiency immune-mediated by non-neutralizing antibodies and subsequent increased clearance.
Highlights
Results and DiscussionA 70-year-old male with no relevant past medical history and a recently diagnosed metastatic non-small cell lung cancer (NSCLC) was admitted for priapism
Factor XIII (FXIII) is a pro-coagulant plasma protein, essential in the primary stabilization of the clot by cross-linking fibrin strands [1]
A 70-year-old male with no relevant past medical history and a recently diagnosed metastatic non-small cell lung cancer (NSCLC) was admitted for priapism
Summary
We describe a case of a 70-year-old male with a good performance status and a past medical history of arterial hypertension, post-traumatic stress disorder and prior smoking history. Chest CT confirmed the presence of a subpleural pulmonary nodule in the upper segment of the right lower lobe, suspicious of primary lung cancer, as well as mediastinal enlarged lymph nodes Three months later he was admitted at our institution due to a one weeklong cryptogenic ischemic priapism, causing an acute urinary retention, with fever and increased inflammatory parameters. After 48 hours, mucocutaneous bleeding increased and a newly performed CT scan revealed de novo multiple intra-pelvic and right thigh haematomas. At this time, coagulation and platelet study was repeated and no significant alterations were observed. To the best of our knowledge, this is the first reported case of acquired FXIII deficiency in a patient with metastatic NSCLC
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