TROUSSEAU'S SYNDROME ACCOMPANIED BY ADVANCED PROSTATE CANCER THAT DEVELOPED ISCHEMIC STROKE; A CASE REPORT

Abstract

Trousseau's syndrome is known as a thromboembolic disorder due to hypercoagulation accompanied with advanced cancer. A 67-year-old man presented with disequilibrium and back pain, and magnetic resonance imaging of his brain indicated multiple cerebral infarctions at the acute stage. A computed tomography scan showed enlargement of multiple paraaortic lymph nodes. From these findings, we suspected that this patient had Trousseau's syndrome. The patient started anticoagulant treatment involving constant infusion with heparin Na. We also examined the origin of enlarged multiple paraaortic lymph nodes by investigating the tumor markers, which showed that the prostate specific antigen value (PSA) was extremely high. We conducted a prostatic biopsy and the pathological findings showed prostate cancer. The Combined Androgen Blockade (CAB) therapy was effective in reducing PSA value and shrinkage of the paraaortic lymph nodes. After the blood coagulation ability was improved to a normal state, we changed the anticoagulant treatment to subcutaneous injection of heparin Ca. There was no recurrence of cerebral infarction and no regrowth of prostate cancer 6 months after CAB therapy. Trousseau's syndrome is known as a poor prognosis syndrome because there is no effective therapy for the advanced stage of the accompanying cancer. However, CAB therapy is effective for advanced prostate cancer and long-term prognosis is expected. Starting anticoagulant treatment at the acute stage and maintaining anticoagulant treatment at the chronic stage are important in the treatment of Trousseau's syndrome accompanied with prostate cancer.