Disseminated Intravascular Coagulation as the Initial Presentation of Metastatic Prostate Adenocarcinoma

Disseminated intravascular coagulation (DIC) can be caused by cancer. However, it is rare to be the presenting sign of malignancy. The manifestations of bleeding or thrombosis in DIC depend on the balance of the fibrinolytic system. This case centers on a 52-year-old male who presented with DIC and spontaneous bruising, and no obvious cause for DIC. He was found to have metastatic prostate adenocarcinoma. DIC related to solid tumors typically have an indolent course and is only apparent on laboratory analysis. Further, DIC with excessive fibrinolysis in prostate cancer is associated with lower median survival. Treatment involves treating prostate cancer, and supportive treatment with blood products. Epsilon-aminocaproic acid may have a role in life-threatening bleeds, while prophylactic heparin treatment can be given for DIC associated with thrombosis.