Trousseau's syndrome in patient with pancreatic cancer: case study

In 1865, in his lecture «Phlegmasia Alba Dolens», a great French clinician Armand Trousseau noted a connection between idiopathic venous thrombosis and malignant diseases. Several years later, he noted the appearance of thrombophlebitis of his own left hand, followed by the manifestation of stomach cancer, from which he died. The syndrome in which migratory thrombophlebitis precedes the clinical manifestation of malignant neoplasms of the internal organs, was subsequently named in memory of Trusso. The article presents a clinical case of Trousseau's syndrome in a patient in whom the diagnostic search revealed pancreatic cancer. The patient was initially admitted to the cardiology department with a preliminary diagnosis of acute coronary syndrome. The diagnostic search revealed thrombotic manifestations (pulmonary embolism, deep vein thrombophlebitis of both lower extremities), as well as changes in the liver with increased levels of liver enzymes. Trousseau's syndrome was suspected: a cancer search was performed and revealed signs of pancreatic cancer (changes in the pancreas reveled by the ultrasound and abdominal CT; an ultrahigh level of the CA 19-9 tumor marker) with liver metastases. The diagnosis was not histologically confirmed due to the risk of bleeding during anticoagulant therapy. Unfortunately, the patient died from repeated massive pulmonary embolism. Autopsy confirmed the diagnosis of pancreatic cancer with multiple liver metastases and revealed signs of pulmonary artery thrombosis and deep vein thrombosis of the lower extremities. The awareness of Trousseau's syndrome can guide physicians to search for cancer in patients with «idiopathic» thrombophlebitis. 

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