Recurrent Disseminated Intravascular Coagulation in Metastatic Castration-Resistant Prostate Cancer: A Case Report.
Benjamin GiszasMichael FritzenwangerMarc-Oliver GrimmAndreas StallmachPhilipp Alexander ReukenPublished in: Diagnostics (Basel, Switzerland) (2022)
Disseminated intravascular coagulation (DIC) is a systemic disease characterized by simultaneous thrombosis, bleeding, and partially excessive fibrinolysis. Systemic shock, trauma, bacterial toxins, and procoagulants-expressing solid and hematologic malignancies are common causes of this life-threatening hemorrhagic complication and often require treatment in intensive care units. We describe a case of an elderly man with recurrent severe bleeding events in the cause of DIC, including epistaxis, hemoptysis, hematuria, and gastrointestinal bleeding. Laboratory investigations revealed elevated prostate-specific antigen (PSA), suggesting an underlying prostate cancer. Despite intensified coagulatory therapy, the coagulation disorder could not be stabilized. A single injection of degarelix, a gonadotropin-releasing hormone (GnRH) receptor antagonist, led to rapid stabilization of the coagulation and decreased PSA within days. One year after initiating androgen-deprivation therapy, there were recurrent transfusion-requiring bleeding events, and a concomitant PSA increase occurred, suggesting metastatic castration-resistant disease associated with DIC. This case emphasizes DIC as a possible primary phenomenon and indicator for the progression of the underlying malignancy, as well as the importance of etiological therapies in the management of DIC.
Keyphrases
- prostate cancer
- radical prostatectomy
- atrial fibrillation
- squamous cell carcinoma
- intensive care unit
- small cell lung cancer
- coronary artery
- pulmonary embolism
- cardiac surgery
- replacement therapy
- weight gain
- mechanical ventilation
- acute kidney injury
- community dwelling
- combination therapy
- loop mediated isothermal amplification