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Small Cell Lung Cancer Presenting as Severe Thrombocytopenia and Refractory Hypokalemia

A 70-year-old female with a history of mild cirrhosis was referred by her primary care provider for a platelet count of 36,000/μL which had dropped from 47,000/μL in a week along with mild pain in extremities. Serum potassium was low (2.9 mEq/L) in spite of the patient being recently started on pota...

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Autores principales: Mandaliya, Rohan, Hughes, Lesley, Auerbach, Herbert, LePar, Felice
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Hindawi Publishing Corporation 2014
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4052468/
https://www.ncbi.nlm.nih.gov/pubmed/24959367
http://dx.doi.org/10.1155/2014/874831
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author Mandaliya, Rohan
Hughes, Lesley
Auerbach, Herbert
LePar, Felice
author_facet Mandaliya, Rohan
Hughes, Lesley
Auerbach, Herbert
LePar, Felice
author_sort Mandaliya, Rohan
collection PubMed
description A 70-year-old female with a history of mild cirrhosis was referred by her primary care provider for a platelet count of 36,000/μL which had dropped from 47,000/μL in a week along with mild pain in extremities. Serum potassium was low (2.9 mEq/L) in spite of the patient being recently started on potassium supplement on outpatient for hypokalemia. Initially thrombocytopenia was attributed to cirrhosis. However, platelet counts continued to drop to a nadir of 9000/μL in spite of several platelet transfusions. Hypokalemia was refractory to potassium supplements. Subsequent bone marrow biopsy revealed extensive marrow necrosis with a focus of small cell tumor cells of pulmonary origin. CT scan of the chest showed a spiculated left lung mass. The ACTH level was high, with normal rennin and aldosterone levels. The patient likely had ectopic ACTH syndrome from small cell lung cancer. She died within few days of diagnosis. Severe thrombocytopenia and refractory hypokalemia can rarely be initial presentations of small cell lung cancer. Thrombocytopenia should prompt an evaluation for bone marrow metastases and a search for undiagnosed systemic malignancy. In severe cases of metastases, bone marrow necrosis can be present. Refractory hypokalemia can be the sole presentation of ectopic ACTH production.
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spelling pubmed-40524682014-06-23 Small Cell Lung Cancer Presenting as Severe Thrombocytopenia and Refractory Hypokalemia Mandaliya, Rohan Hughes, Lesley Auerbach, Herbert LePar, Felice Case Rep Oncol Med Case Report A 70-year-old female with a history of mild cirrhosis was referred by her primary care provider for a platelet count of 36,000/μL which had dropped from 47,000/μL in a week along with mild pain in extremities. Serum potassium was low (2.9 mEq/L) in spite of the patient being recently started on potassium supplement on outpatient for hypokalemia. Initially thrombocytopenia was attributed to cirrhosis. However, platelet counts continued to drop to a nadir of 9000/μL in spite of several platelet transfusions. Hypokalemia was refractory to potassium supplements. Subsequent bone marrow biopsy revealed extensive marrow necrosis with a focus of small cell tumor cells of pulmonary origin. CT scan of the chest showed a spiculated left lung mass. The ACTH level was high, with normal rennin and aldosterone levels. The patient likely had ectopic ACTH syndrome from small cell lung cancer. She died within few days of diagnosis. Severe thrombocytopenia and refractory hypokalemia can rarely be initial presentations of small cell lung cancer. Thrombocytopenia should prompt an evaluation for bone marrow metastases and a search for undiagnosed systemic malignancy. In severe cases of metastases, bone marrow necrosis can be present. Refractory hypokalemia can be the sole presentation of ectopic ACTH production. Hindawi Publishing Corporation 2014 2014-05-15 /pmc/articles/PMC4052468/ /pubmed/24959367 http://dx.doi.org/10.1155/2014/874831 Text en Copyright © 2014 Rohan Mandaliya et al. https://creativecommons.org/licenses/by/3.0/ This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Case Report
Mandaliya, Rohan
Hughes, Lesley
Auerbach, Herbert
LePar, Felice
Small Cell Lung Cancer Presenting as Severe Thrombocytopenia and Refractory Hypokalemia
title Small Cell Lung Cancer Presenting as Severe Thrombocytopenia and Refractory Hypokalemia
title_full Small Cell Lung Cancer Presenting as Severe Thrombocytopenia and Refractory Hypokalemia
title_fullStr Small Cell Lung Cancer Presenting as Severe Thrombocytopenia and Refractory Hypokalemia
title_full_unstemmed Small Cell Lung Cancer Presenting as Severe Thrombocytopenia and Refractory Hypokalemia
title_short Small Cell Lung Cancer Presenting as Severe Thrombocytopenia and Refractory Hypokalemia
title_sort small cell lung cancer presenting as severe thrombocytopenia and refractory hypokalemia
topic Case Report
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4052468/
https://www.ncbi.nlm.nih.gov/pubmed/24959367
http://dx.doi.org/10.1155/2014/874831
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