Abstract
Disseminated intravascular coagulation (DIC) can be caused by cancer. However, it is rare to be the presenting sign of malignancy. The manifestations of bleeding or thrombosis in DIC depend on the balance of the fibrinolytic system. This case centers on a 52-year-old male who presented with DIC and spontaneous bruising, and no obvious cause for DIC. He was found to have metastatic prostate adenocarcinoma. DIC related to solid tumors typically have an indolent course and is only apparent on laboratory analysis. Further, DIC with excessive fibrinolysis in prostate cancer is associated with lower median survival. Treatment involves treating prostate cancer, and supportive treatment with blood products. Epsilon-aminocaproic acid may have a role in life-threatening bleeds, while prophylactic heparin treatment can be given for DIC associated with thrombosis.
Highlights
The estimated incidence of disseminated intravascular coagulation (DIC) in prostate cancer is 13-30%
The clinical signs of DIC are only present in 0.4-1.65% of prostate cancer, and most of them are asymptomatic [1]
We highlight a patient who presented with thrombocytopenia and spontaneous bruising, labs indicative of DIC, and found to have metastatic prostate adenocarcinoma
Summary
The estimated incidence of disseminated intravascular coagulation (DIC) in prostate cancer is 13-30%. A 52 year-old male with history of heart failure with reduced ejection fraction and hypertension initially presented to an outside hospital with generalized fatigue and back pain He was found to be thrombocytopenic, but records did not indicate the platelet count. On his discharge from the outside hospital, and eight days prior to admission to our hospital, his platelet count was 51 k/mm, with a normal white blood cell count and hemoglobin. At an outpatient hematology visit, his platelet count was noted to be lower (unknown value), and he developed new ecchymosis on his right calf, so he was referred back to the emergency department at an outside hospital He was transferred to our institution for further evaluation. He was started on leuprolide and docetaxel and discharged with plans to continue chemotherapy outpatient
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