School of Medicine, Tehran University of Medical Sciences, Tehran, Iran.
Department of Internal Medicine, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran.
Cancer Rep (Hoboken). 2023 Sep;6(9):e1868. doi: 10.1002/cnr2.1868. Epub 2023 Jul 12.
Disseminated intravascular coagulation (DIC) has been reported in various solid malignancies and is a common coagulation-related complication in prostate cancer. However, DIC has been rarely reported as the initial presentation of prostate cancer. Herein, we reported a patient referring with subdural hemorrhage (SDH) and DIC with an unexplained cause who was later diagnosed with prostate cancer.
We presented a 68-year-old man who was referred to the hospital with a gradual deterioration of consciousness, dyspnea, and edema in the genitalia and lower limbs. His primary laboratory tests showed elevated prothrombin time (PT) and partial thromboplastin time (PTT) and a decreased fibrinogen level of 47 mg/dL [200-400 mg/dL]. The DIC score was 7, which was suggestive of DIC. Moreover, cranial imaging showed SDH. Further work-up revealed elevated prostate-specific antigen and prostate enlargement with a mass effect on the bladder with a bone lesion, which was suggestive of metastatic prostate cancer.
This report highlights DIC as a possible initial presentation of an underlying malignancy, as well as the importance of treatment of underlying disease in the management of DIC. A comprehensive and systematic work-up is essential for early diagnosis in patients with DIC to avoid further complications and mortality.
弥散性血管内凝血（DIC）已在各种实体恶性肿瘤中报道，是前列腺癌中常见的与凝血相关的并发症。然而，DIC 作为前列腺癌的初始表现很少见。在此，我们报告了一例以硬脑膜下血肿（SDH）和原因不明的 DIC 就诊的患者，后来被诊断为前列腺癌。
我们介绍了一位 68 岁的男性患者，他因逐渐恶化的意识、呼吸困难以及生殖器和下肢水肿而被转诊至医院。他的初步实验室检查显示凝血酶原时间（PT）和部分凝血活酶时间（PTT）升高，纤维蛋白原水平降低至 47mg/dL[200-400mg/dL]。DIC 评分为 7，提示 DIC。此外，头颅成像显示 SDH。进一步的检查显示前列腺特异性抗原升高，前列腺肿大，对膀胱有肿块效应，并伴有骨病变，提示转移性前列腺癌。
本报告强调了 DIC 可能是潜在恶性肿瘤的初始表现，以及治疗潜在疾病在 DIC 管理中的重要性。对于 DIC 患者，全面系统的检查对于早期诊断至关重要，以避免进一步的并发症和死亡率。
