Successful chemotherapy management of disseminated intravascular coagulation presenting with metastatic clear cell renal carcinoma: a case report and review of the literature

• Published in: Journal of medical case reports 2020-04, Vol.14 (1), p.52-52, Article 52
• Main Authors: Le Trinh, Huy, Nguyen, Vuong Thi, Mai, Ngan Kim, Tran, Bach Trung, Pham, Quynh Nga
• Format: Article
• Language: English
• Subjects: Aged; Antineoplastic Combined Chemotherapy Protocols - therapeutic use; Back pain; Blood platelets; Bone marrow; Cancer diagnosis; Cancer metastasis; Cancer therapies; Carboplatin; Carcinoma; Carcinoma, Renal Cell - diagnosis; Carcinoma, Renal Cell - pathology; Case Report; Case reports; Chemotherapy; Cisplatin - therapeutic use; Clear cell renal cell carcinoma; Cytotoxicity; Disease; Disseminated intravascular coagulation; Disseminated Intravascular Coagulation - drug therapy; Disseminated Intravascular Coagulation - etiology; Humans; Immunohistochemistry; Kidney cancer; Laboratories; Male; Metastasis; Paclitaxel - therapeutic use; Patients; Sorafenib; Thrombosis; Tumors
• ISSN: 1752-1947; 1752-1947
• DOI: 10.1186/s13256-020-02369-x

Disseminated intravascular coagulation is a critical complication of advanced clear cell renal cell carcinoma, despite the rarity of the occurrence of disseminated intravascular coagulation in such tumors. The diagnosis of cancer-related disseminated intravascular coagulation is mostly based on clinical bleeding and laboratory test; available data suggest that treating the primary cancer also treats the disseminated intravascular coagulation. Among three reported cases of renal cell carcinoma-related disseminated intravascular coagulation in the literature, this is the first patient whose disseminated intravascular coagulation was successfully treated, in particular, with chemotherapy without any anti-disseminated intravascular coagulation therapies. This case is a 66-year-old Vietnamese man who presented disseminated intravascular coagulation 2 weeks after his admission for severe back pain. At admission, his initial laboratory work-up revealed only a mild thrombocytopenia with a platelet count of 93 × 10 /L (normal range, 150-450 × 10 /L) without clinical bleeding. His past medical history and family history were unremarkable. An open-biopsy was performed and the definitive diagnosis was bone metastatic clear cell renal cell carcinoma based on immunohistochemistry. Two weeks after admission, the diagnosis of disseminated intravascular coagulation was confirmed according to the International Society on Thrombosis and Haemostasis. Immediately, he was treated with a paclitaxel plus carboplatin regimen and disseminated intravascular coagulation completely disappeared after one cycle of systemic chemotherapy. Until recently, 11 months subsequent to the diagnosis of disseminated intravascular coagulation, he had been being undergoing maintenance therapy for metastatic clear cell renal cell carcinoma. First, an early detection of overt disseminated intravascular coagulation is essential, although disseminated intravascular coagulation in cancer presents as a chronic or even subclinical process with unique thrombocytopenia. Second, making a decision of systemic chemotherapy without delay at the time of disseminated intravascular coagulation diagnosis is the key to successful cancer-related disseminated intravascular coagulation treatment.