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( Monica Palma Anselmo ),( Gustavo Nobre De Jesus ),( Joao Madeira Lopes ),( Rui M M Victorino ),( Joao Meneses Santos ) 대한내과학회 2014 대한내과학회 추계학술대회 Vol.2014 No.1
Disseminated intravascular coagulation (DIC) is the most frequent coagulation disorder associated with metastatic prostate adenocarcinoma. However, DIC as an initial presentation of prostate cancer with primary fi brinolysis is extremely rare. The appropriate treatment to control bleeding in these situations is challenging, controversial and based on isolated case reports in the literature. A 66-year-old male presented at the emergency department with acute severe spontaneous ecchymoses localized to the limbs, latero-cervical hematoma and hemothorax. Prostate specifi c antigen level was 385 μg/L, bone scintigraphy revealed multiple bone metastases and prostate biopsy confi rmed adenocarcinoma (Gleason 9; 4+5). Laboratory investigation showed a pattern of primary fi brinolysis rather than the more common intravascular coagulation mechanism. Epsilon aminocaproic acid in monotherapy was initiated with a clear and rapid control of bleeding manifestations. This rare case of massive bleeding due to hyperfi brinolysis as the fi rst manifestation of prostate cancer suggests that in selected cases where the acute bleeding dyscrasia is clearly associated to a dominant fi brinolysis mechanism it is possible to use an approach of monotherapy with antifi brinolytics.