Multiple hemorrhagic strokes from DIC associated with occult large cell carcinoma

Background and Purpose: Multiple hemorrhagic strokes are a rare presentation of paraneoplastic disseminated intravascular coagulation (DIC). We present a case of DIC occurring in a patient with occult large cell carcinoma. Summary of Case: A 77-year old Asian-American man presented with 1 month of vision disturbance followed by acute onset of left hemiparesis and encephalopathy. He was found to have three strokes of varying ages, and was placed on aspirin and clopidogrel. He returned 4 days later with hemorrhagic conversion of the strokes and laboratory abnormalities suggestive of DIC. Over the hospital course, he suffered recurrent ischemic strokes and intracerebral hemorrhages despite management of his coagulopathy. On autopsy, an occult large cell carcinoma was found in the hilar lymph nodes, as well as multiple intravascular thrombi. Conclusions: Recurrent hemorrhagic strokes associated with DIC may be the initial presentation of occult malignancy. Although adenocarcinoma is classically associated with paraneoplastic DIC, this case demonstrates that large cell carcinoma may also be implicated.