P2247 - Acute Disseminated Intravascular Coagulation: A Rare Complication of Poorly Differentiated Esophageal Adenocarcinoma

Jigisha Srivastav, MD¹, Caio Rocha Lima, MD^2
1Wake Forest Baptist Health, Winston-Salem, NC; ²Atrium Health Wake Forest Baptist, Winston-Salem, MD

Introduction: Disseminated intravascular coagulation (DIC) is a rare and serious condition that involves widespread blood clotting and bleeding throughout the body due to abnormal activation of the coagulation system. The most common malignancies that lead to DIC are hematological and mucin producing solid tumors. Below we describe a rare case of acute DIC shortly after the diagnosis of poorly differentiated esophageal adenocarcinoma.

Case Description/Methods: A 53-year-old male with multiple comorbidities presented with progressive dysphagia and significant weight loss over three months. Endoscopy revealed a 35 cm esophageal malignant mass diagnosed as poorly differentiated esophageal adenocarcinoma with signet ring cell features. While undergoing further workup, patient developed worsening anemia, melena, and hematochezia, leading to hospitalization with repeat endoscopy revealing oozing esophageal mass with hemospray applied. Laboratory analysis was concerning for DIC with fibrinogen level of 103, d-dimer 15,640, and peripheral blood smear with schistocytes. Imaging revealed metastatic disease. Treatment included multiple units of cryoprecipitate and vitamin K. He was also initiated on FOLFOX chemotherapy. While initially showing improvement, he experienced worsening thrombocytopenia and subsequent DIC recurrence requiring readmission and further treatment. Unfortunately, he deteriorated rapidly and passed away due to respiratory complications.

Discussion: This case highlights that patients with poorly differentiated esophageal adenocarcinoma may develop rare complications such as DIC. Malignancy can trigger DIC through mechanisms such as vascular invasion, procoagulant release, and inflammation. Prompt diagnosis and treatment of DIC is crucial due to potential impact on patient outcomes. Having a multidisciplinary team taking care of these patients is essential. Although chemotherapy initially treated both the malignancy and DIC, the aggressive nature of the malignancy led to DIC recurrence. Further research is needed to better understand and manage this complex clinical situation.


Disclosures:


Jigisha Srivastav, MD¹, Caio Rocha Lima, MD². P2247 - Acute Disseminated Intravascular Coagulation: A Rare Complication of Poorly Differentiated Esophageal Adenocarcinoma, ACG 2024 Annual Scientific Meeting Abstracts. Philadelphia, PA: American College of Gastroenterology.