Thrombotic microangiopathy as a presentation of undifferentiated metastatic carcinoma, a case report

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Filipa Margarida Ferreira Pereira
Ana Elisa Costa
Margarida Freitas Silva

Keywords

thrombotic microangiopathy, thrombotic thrombocytopenic purpura, cancer

Abstract

Thrombotic microangiopathy (TMA) is a group of hereditary or acquired syndromes that shared clinical and pathological characteristics: microvascular thrombosis, thrombocytopenia and ischaemic end-organ damage. Thrombotic microangiopathy can be a manifestation of a subjacent disease as cancer, infection, auto-immune disease and others. Patients presenting cancer-related TMA have an extremely poor prognosis. We report a case of a 61-year-old man who was admitted for persistent lumbar pain. Results from imagiological exams showed multiple retroperitoneal lymph nodes suggestive of metastatic cancer. A sudden clinical episode with changes in mental and behavioral status and laboratory alterations consistent with TMA, were observed. A first strategy including plasma exchange and steroids was performed with no clinical response. The retroperitoneal lymph node biopsy revealed undifferentiated carcinoma of unknown primary and then, chemotherapy was started.

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