CRA74 NSCLC ADENOCARCINOMA BEYOND THE LUNGS: A CASE OF CANCER-ASSOCIATED DISSEMINATED INTRAVASCULAR COAGULATION PRESENTING WITH DEVASTATING THROMBOTIC EVENTS

Ken Nee Ong, Shailesh Anand A/L Baskaran, Kim Lim Koo, Nik Natasha Hani Binti Nik Isahak, Nadiah Saqiinah Binti Abdul Jalil, Hui-Xin Tan

Respiratory Unit, Internal Medicine Department, Hospital Sungai Buloh, Selangor, Malaysia

Thromboembolic events are well-known complications in cancer patients. However, reports on Disseminated Intravascular Coagulation (DIC) as a potential paraneoplastic phenomenon arising from advanced-stage solid tumors such as adenocarcinomas remain scarce. The pathophysiology underlying this phenomenon involves tumor-derived procoagulant substances entering systemic circulation, disrupting normal coagulation pathways.

We report a case of a previously healthy 36-year-old woman, who presented with a massive left-sided pleural effusion. Pleuroscopy and biopsy confirmed Non-Small Cell Lung Carcinoma Adenocarcinoma. Initially, her only abnormal laboratory finding was a mildly prolonged activated partial thromboplastin time. However, 72 hours post-procedure, she developed sudden-onset blindness secondary to bilateral occipital lobe infarcts identified on neuroimaging. This coincided with a rapid deterioration in her blood parameters, including thrombocytopenia and laboratory evidence of DIC. Subsequently, she developed right acute limb ischemia, prompting initiation of intravenous heparin.

Given the rapid and severe progression in which we contributed to paraneoplastic DIC driven by the underlying malignancy, we decided to empirically treat with oral Tyrosine Kinase Inhibitor (TKI). This is an attempt to reduce tumour burden and mitigate catastrophic coagulopathy. Despite aggressive management, her condition deteriorated rapidly, culminating in cardiac arrest and death.

This case report highlights the potential lethality and under-recognized nature of paraneoplastic DIC associated with advanced adenocarcinomas. Early detection, a high index of suspicion, and prompt oncologic intervention may be lifesaving, although prognosis remains guarded even with optimal care.