Atypical Presentation of Disseminated Intravascular Coagulation with Synchronous Peripheral Venous Thromboembolism and Arterial Gangrene in a Pancreatic Cancer Patient: A Case Report

  • Tulay Kus Division of Oncology, Department of Internal Medicine, University of Gaziantep. Gaziantep, Turkey
  • Mehmet Emin Kalender Division of Oncology, Department of Internal Medicine, University of Gaziantep. Gaziantep, Turkey
  • Gokmen Aktas Division of Oncology, Department of Internal Medicine, University of Gaziantep. Gaziantep, Turkey
  • Ali Suner Division of Oncology, Department of Internal Medicine, University of Adiyaman. Gaziantep, Turkey
  • Celaletdin Camci Division of Oncology, Department of Internal Medicine, University of Gaziantep. Gaziantep, Turkey
Keywords: Adenocarcinoma, Disseminated Intravascular Coagulation, Mesenteric Ischemia

Abstract

Context Cancer is a prothrombotic state and anticancer therapies are often complicated by vascular events. The risk of developing thromboembolic events is substantially increased in patients with pancreatic cancer. One possible presentation of vascular events in pancreatic cancer is disseminated intravascular coagulation (DIC). Case report In our case a patient with a diagnosis of pancreatic cancer initially presented with thrombosis and received low molecular weight heparin (LMWH) in addition to standard chemotherapy regimen. He was thought to have DIC by assessment of clinical and laboratory findings. Conclusion Clinically, thrombosis was first located in the left femoral vein and encountered at right femoral artery after three weeks. This pattern was an unusual presentation of DIC. Subclinical DIC is common in patients presenting with pancreatic cancer and is considered a ‘poor’ prognostic factor. Acute DIC, on the other hand is a potentially mortal condition.

Image: The legs 7 weeks after diagnosis.

Downloads

Download data is not yet available.

References

Siegel R, Ma J, Zou Z, Jemal A. Cancer statistics, 2014. CA Cancer J Clin 2014; 64: 9-29. [PMID: 24399786]

Epstein AS, Soff GA, Capanu M, Crosbie C, Shah MA, Kelsen DP, Denton B, Gardos S, O'Reilly EM. Analysis of Incidence and Clinical Outcomes in Patients With Thromboembolic Events and Invasive Exocrine Pancreatic Cancer. Cancer 2012; 118: 3053-61. [PMID: 21989534]

Majumder S, Thom T, Dasanu CA. Catastrophic Arteriovenous Thromboembolism as Initial Manifestation of Pancreatic Cancer. J Pancreas 2012; 13: 231-234. [PMID: 22406609]

Tanaka K, Imamura T. Incidence and clinicopathological significance of DIC in autopsy cases. Bibl Haematol 1983; 49: 79-93. [PMID: 6667256]

Taylor FB Jr, Toh CH, Hoots WK, Wada H, Levi M. Towards definition, clinical and laboratoty criteria, and scoring system for disseminated intravascular coagulation. Thromb Haemos 2001. 86: 1327-1330. [PMID: 11816725]

Khorana AA, Francis CW, Culakova E, Kuderer NM, Lyman GH. Thromboembolism is a leading cause of death in cancer patient receiving out patient chemotherapy. J Thromb Haemost 2007; 5: 632. [PMID: 17319909]

Chew HK, Wun T, Harvey D, Zhou H. White RH. Incidence of venous thromboembolism and its effect on survival among patients with common cancers. Arch Intern Med 2006; 166: 458. [PMID: 16505267]

Baccaccio C. Comoglio PM. Genetic link between cancer and thrombosis. J Clin Oncol 2009; 27: 4827. [PMID: 19738115]

Yu JL, May L, Lhotak V, Shahrzad S, Shirasawa S, Weitz JI, Coomber BL, Mackman N, Rak JW. Oncogenic events regulate tissue factor expression in colorectal cancer cell implication for tumor progression and angiogenesis. Blood 2005; 105: 1735. [PMID: 15494427]

Belting M, Ahamed J, Ruf W. Signaling of the tissue factor coagulation pathway in angiogenesis and cancer. Arterioscler Thromb Vasc Biol 2005; 25: 1545. [PMID: 15905465]

Levine M. Treatment of thrombotic disorders in cancer patients. Haemostasis 1997; 27 Suppl 1: 38.

Levi M, Toh CH, Thachil J, Watson HG. Guidelines for the the diagnosis and management of disseminated intravascular coagulation. British Committee for standart Standarts ın Haematology. Br J Haematol 2009; 145; 24. [PMID: 19222477]

Levi M. Disseminated intravascular coagulation: What's new?. Crit Care Clin 2005; 21: 449-67. [PMID: 15992667]

Phan M, John S, Casanegra AI, Rathbun S, Mansfield A, Stoner JA, Tafur AJ. Primary venous thromboembolism prophylaxis in patients with solid tumors: a meta-analysis. J Thromb Thrombolysis 2014; 38: 241-9. [PMID: 24233387]

The legs 7 weeks after diagnosis
Published
2015-03-20
How to Cite
KusT., KalenderM., AktasG., SunerA., & CamciC. (2015). Atypical Presentation of Disseminated Intravascular Coagulation with Synchronous Peripheral Venous Thromboembolism and Arterial Gangrene in a Pancreatic Cancer Patient: A Case Report. JOP. Journal of the Pancreas, 16(2), 195-197. https://doi.org/10.6092/1590-8577/2943
Section
CASE REPORTS