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Logo of bmjcrInstructions for authorsCurrent ToCBMJ Case Reports
BMJ Case Rep. 2010; 2010: bcr0120091471.
Published online Jul 8, 2010. doi:  10.1136/bcr.01.2009.1471
PMCID: PMC3027077
Novel treatment (new drug/intervention; established drug/procedure in new situation)
Massive hypercoagulable state despite full-dose anticoagulant treatment in a patient with occult malignancy: considerations concerning chemotherapy without definitive diagnosis
Kathrin Ehren,1 Christof Lamberti,2 Bernd Poetzsch,3 Michael Majores,4 Katharina Strach,5 Tilman Sauerbruch,1 and Jan-Christian Wasmuth1
1Department of Internal Medicine I, University Hospital Bonn, Bonn, Germany
2Oncology, Klinikum Coburg, Coburg, Germany
3Institute of Experimental Hematology and Transfusion Medicine, University Hospital Bonn, Bonn, Germany
4Department of Pathology, University Hospital Bonn, Bonn, Germany
5Department of Radiology, University Hospital Bonn, Bonn, Germany
Correspondence to Kathrin Ehren, kathrin.ehren/at/
A 55-year-old female patient presented with recurrent deep venous thrombosis and pulmonary embolism while on oral anticoagulant treatment using the vitamin K antagonist phenprocoumon. Hypercoagulable state was regarded to be paraneoplastic, but no underlying malignancy could be identified despite extensive screening for cancer, including gastroscopy and colonoscopy, a bone marrow biopsy, thoracoabdominal CT scans with subsequent biopsies of possibly malignant findings, octreotide scintigraphy, skeletal scintigraphy and gynaecological screening. In the course of her hospital stay she developed progressive right cardiac insufficiency due to the formation of new thromboses despite aggressive anticoagulant treatment and died of right-sided heart failure. The autopsy showed a poorly differentiated adenocarcinoma in the middle lobe of the right lung. In addition, pulmonary lymphangiosis carcinomatosa, pleural and pericardial carcinosis, and lymph node metastases and osteoblastic vertebral body metastases were shown.
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