Paraneoplastic Leukocytosis: A Poor Prognostic Marker in Pancreatic Adenocarcinoma

Hyperleukocytosis is a rare form of paraneoplastic syndrome that has been reported in adenocarcinomas, particularly pancreatic cancer. We present an elderly man with chronic abdominal pain and weight loss for six months. On examination, he had diffuse tenderness and marked ascites. A workup with a CT scan revealed a pancreatic mass, which was confirmed to be pancreatic adenocarcinoma on biopsy. His lab work showed a significant leukocytosis. An extensive infectious workup was negative. He was not on any medications known to cause a leukocytosis; therefore, his leukocytosis was attributed to his cancer. Unfortunately, he died just a few days later. This case highlights hyperleukocytosis as a paraneoplastic syndrome that is a poor prognostic sign, and can be used as a marker for disease progression.