warfarin and Adenocarcinoma--Clear-Cell

We describe a 58-year old female patient with rapid development of arterial and venous thromboembolisms, including deep vein thrombosis (DVT) in the lower limbs, recurrent cerebral infarctions and bilateral pulmonary emboli. Her laboratory data on admission showed positive anticardiolipin antibody of IgG isotype (IgG aCL) and positive anti-beta2 glycoprotein-I antibody of IgG isotype (IgG abeta2-GPI), and decreased protein C activity and protein S antigen. Systemic examinations revealed the presence of an ovarian cancer. Surgical resection was attempted, but her cancer infiltrated the pelvic wall and could not be resected. Despite treatment with unfractionated heparin followed by warfarin, she died due to recurrent episodes of cerebral infarction. This case was considered as probable catastrophic antiphospholipid syndrome (CAPS), which might be associated with ovarian cancer. Known as Trousseau's syndrome, arterial and, more commonly, venous thrombosis is a frequent complication of cancer and sometimes a harbinger of occult cancer. Our case indicates that there is an overlap between antiphospholipid syndrome (APS) and Trousseau's syndrome. It is important to bear in mind that a thrombotic event associated with cancer can be the first manifestation of CAPS.

Topics: Adenocarcinoma, Clear Cell; Adolescent; Adult; Aged; Anticoagulants; Antineoplastic Combined Chemotherapy Protocols; Antiphospholipid Syndrome; Carboplatin; Cerebral Hemorrhage; Cerebral Infarction; Docetaxel; Fatal Outcome; Female; Humans; Male; Middle Aged; Neoplasms; Neoplasms, Unknown Primary; Ovarian Neoplasms; Palliative Care; Paraneoplastic Syndromes; Protein C Deficiency; Protein S Deficiency; Pulmonary Embolism; Taxoids; Thrombophilia; Thrombophlebitis; Warfarin

Topics: Adenocarcinoma, Clear Cell; Anticoagulants; Female; Hematoma; Humans; Magnetic Resonance Imaging; Middle Aged; Ovarian Neoplasms; Peritoneal Diseases; Pulmonary Embolism; Tomography, X-Ray Computed; Warfarin