Korean J Urogenit Tract Infect Inflamm.  2015 Apr;10(1):53-56. 10.14777/kjutii.2015.10.1.53.

Two Different Coagulopathy Episodes in a Single Patient with Metastatic Prostate Cancer

• Rheem I
• Lee G

• KMID: 1839390
• DOI: http://doi.org/10.14777/kjutii.2015.10.1.53

Abstract

We reported a case of two different episodes of critical coagulopathy in a single patient with metastatic prostate cancer (mPC). The patient initially visited the emergency room with a huge left retroperitoneal hematoma, high serum prostate-specific antigen level, and signs of acute disseminated intravenous coagulation (DIC) from mPC. With blood product replacement and anti-androgen therapy, the DIC-related symptoms and signs were relieved. During the follow-up, he was treated with docetaxel chemotherapy for hormone refractory PC. Four years later, he visited the emergency room again with relapsed coagulopathy and severe anemia that were not replaced with blood products. The laboratory findings were consistent with thrombotic thrombocytopenic purpura rather than DIC. A satisfactory recovery was achieved with a new cycle of docetaxel chemotherapy. Differentiation of the coagulopathies in PC is difficult; therefore, we describe the different features of two overlapping coagulopathies, which will be helpful in deciding on urgent treatment.

Keyword

Disseminated intravascular coagulation; Hemolytic anemia; Prostatic neoplasm

MeSH Terms

Anemia
Anemia, Hemolytic
Dacarbazine
Disseminated Intravascular Coagulation
Drug Therapy
Emergency Service, Hospital
Follow-Up Studies
Hematoma
Humans
Prostate-Specific Antigen
Prostatic Neoplasms*
Purpura, Thrombotic Thrombocytopenic
Dacarbazine
Prostate-Specific Antigen

Figure

• 

  Fig. 1. (A) Computed tomography scan at the 1st episode of coagulopathy demonstrated left retroperitoneal hematoma with contrast medium extravasation and multiple lymph node enlargements around aorta and inferior vena cava. (B) Radio-nucleotide bone scan revealed multiple bone metastases at the 1st episode of coagulopathy. Bone scan at the 2nd episode showed more aggravated bone metastatic lesions than the previous episodes. (C) Clinical course and the levels of serum PSA during the follow up. Arrows for docetaxel chemotherapy, PSA, and MAB. PSA: prostate-specific antigen, MAB: maximal androgen blockade, Lt: left, Rt: right.

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