Secondary Immune Thrombocytopenic Purpura in a Patient with Metastatic Prostate Cancer
DOI:
https://doi.org/10.60591/crspmi.130Keywords:
Antineoplastic Agents/adverse effects, Bicalutamide/adverse effects, Prostatic Neoplasms, Purpura, Thrombocytopenic, IdiopathicAbstract
Prostate neoplasm is the second most prevalent in men and the sixth leading cause of death worldwide. Bicalutamide is a competitive androgen receptor antagonist used in combination in metastatic disease. The best known hematological iatrogenic effects are anemia, and there are also immune manifestations.
We present the case of a patient with a 10-year evolution of prostatic adenocarcinoma with radical prostatectomy and biochemical recurrence with 3 years of evolution and bone metastasis of the right femur, with no known bone marrow involvement, complying with triptorrelin and, more recently, for 5 months, bicalutamide. The patient presents with oral and lower limb petechiae as part of de novo thrombocytopenia (1 x 10^9/L platelets). Once the diagnosis of immune thrombocytopenic purpura (ITP) was confirmed, probably secondary to bicalutamide, it was discontinued, and corticosteroid therapy was simultaneously introduced with a favorable response.
Downloads
References
Sung H, Ferlay J, Siegel RL, Laversanne M, Soerjomataram I, Jemal A, et al. Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2021;71:209–49. doi: 10.3322/caac.21660.
Bagi C. Skeletal implications of prostate cancer. J Musculoskelet Neuronal Interact. 2003;3:112–7.
Vontela NR, Lane RB, Kovesdy C, Weir A. The Incidence and Characterization of ITP in Prostate Cancer. Blood. 2015; 126: 4646. doi: 10.1182/blood.V126.23.4646.4646
Huang JF, Shen J, Li X, Rengan R, Silvestris N, Wang M, et al. Incidence of patients with bone metastases at diagnosis of solid tumors in adults: a large population-based study. Ann Transl Med. 2020;8:482. doi: 10.21037/atm.2020.03.55.
Ghanavat M, Ebrahimi M, Rafieemehr H, Maniati M, Behzad MM, Shahrabi S. Thrombocytopenia in solid tumors: Prognostic significance. Oncol Rev. 2019 May 14;13(1):413. doi: 10.4081/oncol.2019.413.
Nieder C, Haukland E, Pawinski A, Dalhaug A. Anaemia and thrombocytopenia in patients with prostate cancer and bone metastases. BMC Cancer. 2010;10:284. doi:10.1186/1471-2407-10-284
Betsch DM, Gray S, Zed SE. A case of metastatic prostate cancer and immune thrombocytopenia. Curr Oncol. 2017;24:e434-6. doi: 10.3747/co.24.3592.