Naslov
DISSEMINATED INTRAVASCULAR COAGULATION AS AN INDICATOR OF LUNG ADENOCARCINOMA PROGRESSION – A CASE REPORT

Autori
Pečevski, Vesna ; Peček, Mirta ; Seiwerth, Fran ; Janković Makek, Mateja

Vrsta, podvrsta i kategorija rada
Sažeci sa skupova, sažetak, ostalo

Izvornik
BIMCO Journal 2023. / - , 2023, 220-220

Skup
BIMCO 2023

Mjesto i datum
Chernivtsi, Ukrajina, 07.04.2023. - 10.04.2023

Vrsta sudjelovanja
Poster

Vrsta recenzije
Međunarodna recenzija

Ključne riječi
Disseminated intravascular coagulation, lung adenocarcinoma

Sažetak
Various paraneoplastic syndromes are common in lung cancer and may be the first manifestation of the disease, or its progression. Disseminated intravascular coagulation (DIC) is characterized by systemic activation of blood coagulation leading to microvascular thrombosis and bleeding. A 67 year-old man, ex-smoker with a history of arterial hypertension, prostatic hypertrophy and atrial fibrillation, reported to our clinic for scheduled aplication of immunotherapy with pembrolizumab, which he had been receiving since his initial diagnosis of metastatic lung adenocarcinoma two and a half years ago. He was in good general condition, but blood tests showed low platelet count (Plt=42). Given the immunotherapy and recently done PET/CT scan showing stable disease, suspicion of idiopathic thrombocytopenic purpura (ITP) was raised. Corticosteroid therapy was started, while waiting for the results of aditional work-up. Despite corticosteroids, platelet count decreased, while patients' respiratory status worsened. Chest X-ray and CT revealed bilateral progression of infiltrates and newly developed lobar pulmonary embolism. Diagnostic tests confirmed DIC, progression of adenocarcinoma and bilateral postobstructive pneumonia with cavities. In our patient, DIC developed as a paraneoplastic phenomenon due to the progression of adenocarcinoma. His laboratory findings showed thrombocytopenia, immeasurably low fibrinogen level, high D-dimers, while his respiratory worsening was due to the combination of pulmonary embolism and bilateral pneumonia. Upon the treatment with broad spectrum antibiotics and (later) antifungal therapy, and therapeutic dose of low molecular weight heparin despite the low platletes number, patients' status improved and he was able to receive first cycle of the second-line chemotherapy (pemetrexed cisplatin protocol). Gradually, he became oxygen independant and control chest X-ray showed very good regression of bilateral pulmonary infiltrates. With an incidence rate of 6.8% in malignant solid tumors, DIC can develop at any stage of the disease course. If diagnosed during the treatment, it is highly indicative of disease progression. The clinical presentation of DIC varies greatly and a patient-specific approach is necessary to prevent a severe outcome and reduce mortality rates. Management of this condition includes treatment of the underlying disease and supportive therapy.

Izvorni jezik
Engleski

Znanstvena područja
Kliničke medicinske znanosti

POVEZANOST RADA