Purpura as the initial presentation for small-cell lung cancer

Causes of thrombocytopenia (TP) in patients affected by small-cell lung cancer (SCLC) include myelophtysis, immunomediated TP, disseminated intravascular coagulation, thrombotic thrombocytopenic purpura, drug-related TP, and amegakaryocytic TP. However, isolated TP is an exceedingly rare presentation of SCLC.

Here, we report on a 78-year-old Caucasian man with SCLC whose only clinic manifestation at the beginning of his clinical course was a diffuse purpuric rash, indeed due to severe isolated TP. A thorough clinical workup led us to the diagnosis of secondary amegakaryocytic TP, which resolved after chemotherapy.

To the best of our knowledge, this is the first described case of SCLC presenting with amegakaryocytic TP. SCLC should be considered in the differential diagnosis of isolated TP, as should rare triggering conditions like amegakaryocytic TP when evaluating therapeutic opportunities in thrombocytopenic patients.