Ischemic Stroke as First Clinical Evidence of Malignancy-Associated Disseminated Intravascular Coagulation

Abstract

Disseminated intravascular coagulation (DIC) is an acquired clinical and laboratory syndrome that results in excessive and unregulated activation of the coagulation cascade. Although thrombotic manifestations are common, clinically significant cerebral arterial ischemia is rarely reported. We report the case of an 80-year-old man admitted for multifocal stroke, altered coagulation tests, and worsening renal function. After extensive investigation, the diagnosis of multisystem thrombosis in the context of chronic DIC was assumed. A lymph node biopsy documented lung adenocarcinoma metastasis. Therapeutic enoxaparin was started but the patient rapidly deteriorated and died. Thrombotic microangiopathies should be considered in the differential diagnosis of stroke, especially if multifocal and associated with ischemic manifestations in other organs. Chronic DIC can be secondary to mucin-producing solid adenocarcinomas and has been increasingly reported in stage IV lung cancer. The overall prognosis is poor, and anticoagulation is insufficient in the absence of treatment of the underlying disease.