A patient with Trousseau's syndrome and meningeal carcinomatosis due to pancreatic cancer during chemotherapy

Abstract

A 66-year-old female with lesions in the body of the pancreas and liver on computed tomography (CT) scan was diagnosed with adenocarcinoma by endoscopic ultrasound-guided fine needle aspiration (EUS-FNA). She was treated with gemcitabine plus nab-paclitaxel combination therapy (GnP). She presented to our hospital with dysarthria and right hemiparesis eight days later. Magnetic resonance imaging (MRI) scan revealed multiple cerebral infarctions and she was diagnosed with Trousseau's syndrome. Since her neurological symptoms improved spontaneously, we continued systemic chemotherapy and no new neurological symptoms developed. Hypercoagulability was ameliorated by combination chemotherapy with GnP. The pancreatic lesions and hepatic metastases responded partially to systemic chemotherapy. However, metastases to the spine were found 4 months later after 5 courses of GnP. Therefore, we changed the regimen to modified FOLFIRINOX (mFOLFIRINOX). Nausea, appetite loss and vesicorectal disturbances developed 3 months later following 4 courses of mFOLFIRINOX. Meningeal carcinomatosis was diagnosed by cerebrospinal fluid cytology. Her general condition deteriorated and she died three weeks later.