Factor V Leiden mutation triggering four major complications to standard dose cisplatin-chemotherapy for testicular seminoma: a case report

BMC Urology

Case Report

Ralf Gehrckens¹  Petra Anheuser²  Raphael Ikogho²  Klaus-Peter Dieckmann²  Sven Philip Aries³  Wiebke Hollburg⁴ 

[1] Albertinen-Krankenhaus, Department of Diagnostic Radiology, Hamburg, Germany;Albertinen-Krankenhaus, Department of Urology, Suentelstrasse 11a, D-22457, Hamburg, Germany;Elbpneumologie, Mörkenstrasse 47, D-22767, Hamburg, Germany;Hämatologisch-onkologische Praxis Altona (HOPA), Mörkenstrasse 47, D-22767, Hamburg, Germany;

关键词: Seminoma;    Cisplatin chemotherapy;    Thrombosis;    Thrombophilia;    Factor V Leiden;    Bleomycin induced pneumonitis;   

DOI  :  10.1186/s12894-015-0011-z

 received in 2014-11-28, accepted in 2015-02-20,  发布年份 2015

来源: Springer

【 摘 要 】

BackgroundMajor life-threatening complications secondary to cisplatin-based chemotherapy are rare in patients with testicular germ cell tumour (GCT). The incidence of complications increases with dosage of chemotherapy and with a variety of patient-related as well as disease-related conditions. We here report the first case of GCT experiencing as many as four major complications most of which can be explained by the conjunction of several predispositions.Case presentationA 48 year old patient with testicular seminoma and bulky retroperitoneal and mediastinal metastases underwent cisplatin based chemotherapy. During the third cycle of chemotherapy, he developed thrombosis of the central venous port device, subtotal splenic infarction, and Bleomycin induced pneumonitis (BIP). Three months after completion of therapy, he was struck by thalamic infarction. Genetic testing then revealed heterozygote mutation of Factor V Leiden (FVL). He received full-dose warfarin anticoagulation treatment and steroid treatment for BIP. 18 months thereafter, the patient is still disease-free, oncologically. Neurological symptoms have disappeared, but pulmonary dysfunction persists with a vital capacity of 50%.ConclusionThe unique co-incidence of four major complications occurring in this patient were obviously triggered by the genetically determined predisposition of the patient to thrombotic events (FVL). Additionally, several patient-related and disease-related conditions contributed to the unique pattern of complications, i.e. (1) the slightly advanced age (48 years), (2) the prothrombotic condition caused by the disease of cancer, (3) the central venous port device, (4) retroperitoneal bulky metastasis, and (5) cisplatin chemotherapy. Whether or not FVL contributed to the pulmonary fibrosis as well, remains elusive. Practically, in the case of one major vascular complication during cisplatin chemotherapy at standard dose, genetic testing for hereditary thrombophilia should be considered. Thus, precautions for preventing further complications could be initiated.

【 授权许可】

CC BY   
© Dieckmann et al.; licensee BioMed Central. 2015