Abstract
Bone marrow metastasis with profound pancytopenia is an extremely uncommon presentation of breast cancer. Advanced breast cancer can frequently metastasize to bone marrow, but bone marrow failure is not typically seen. Very limited data exist regarding the appropriate management of patients with metastatic breast cancer with profound pancytopenia. Our patient’s initial presentation of anemia and thrombocytopenia was a diagnostic dilemma, later confirmed as metastatic breast cancer on bone marrow biopsy. After diagnosis, treatment was another challenge as there are no predefined treatment guidelines for these patients. After the initial hormonal therapy failed, our patient showed a good clinical response to chemotherapy and her platelet count improved to baseline. This dramatic response to chemotherapy is rare. Therefore, this case represents a rare instance of a diagnostic and therapeutic dilemma with unusual clinical response to chemotherapy.
Highlights
Breast cancer is the most common cancer in women, and it is the most common cause of death in females between age 45 and 55 years in the USA [1]
Saito et al reported that pancytopenia in a patient with metastatic breast cancer is likely caused due to therapyinduced acute myeloid leukemia [12]
Our patient’s initial presentation of breast cancer was pancytopenia which was diagnosed later due to bone marrow failure secondary to metastasis
Summary
Breast cancer is the most common cancer in women, and it is the most common cause of death in females between age 45 and 55 years in the USA [1]. Soon after starting the therapy, she developed immune thrombocytopenia and autoimmune hemolytic anemia The results of her direct antiglobulin test were positive for immunoglobulin G. The patient was started on chemotherapy with capecitabine She had a good response to this therapy with counts slowly returning to reference range over the four to six months. Her follow-up scans showed no new metastatic disease, and we noted significant shrinkage of the known breast mass.
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