Paraneoplastic Hyperfibrinolysis in Oesophageal Adenocarcinoma: A Case Report

Hyperfibrinolysis is a rare but life-threatening coagulopathy that can occur as a paraneoplastic syndrome. It often remains undetected with routine coagulation tests, requiring specialised diagnostics. We present a male patient in his 70s with a history of oesophagectomy for oesophagogastric junction adenocarcinoma who presented with dysphagia, epigastric pain, and spontaneous bruising. Laboratory tests revealed elevated D-dimer, low fibrinogen, and a prolonged prothrombin time. Rotational thromboelastometry (ROTEM) revealed a lysis index at 60 minutes of 53%, consistent with hyperfibrinolysis. Extensive investigations, including imaging and bone marrow biopsy, did not show haematologic malignancy or radiological metastatic disease. A transjugular liver biopsy ultimately confirmed occult metastatic oesophageal adenocarcinoma. This case represents a rare occurrence of primary hyperfibrinolysis linked to oesophageal adenocarcinoma. While the exact pathophysiology remains unclear, it is believed to result from tumour-driven overexpression of fibrinolytic proteins. Given its association with high mortality and poor prognosis, early recognition and intervention are crucial. Standard coagulation tests may fail to detect hyperfibrinolysis, making viscoelastic testing a valuable diagnostic tool. Clinicians should maintain a high index of suspicion for occult malignancy in patients presenting with unexplained bleeding.