SHM Converge Scientific Abstract ePoster Gallery-Doctor My Limb Is Turning Blue !! A Rare Presentation of Paraneoplastic Vascular Syndrome

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A 63-year-old man presented with a 1-month history of a left supraclavicular neck mass and blue discoloration of the left upper extremity. On exam, he had a 3 x 4 cm soft, mobile, nontender left supraclavicular mass and bluish discoloration of the arm. Laboratory studies showed markedly elevated inflammatory and thrombotic markers, including D-dimer 3.81 ug/mL, ESR 74 mm/hr, and CRP 277.81 mg/L. His PSA was extremely elevated at 1000 ng/mL.<br /><br />CT imaging demonstrated cervical nodal masses, extensive thrombosis involving the left internal jugular, brachiocephalic, left subclavian, and left axillary veins, as well as widespread retroperitoneal, para-aortic, and pelvic lymphadenopathy with an enlarged prostate. A retroperitoneal lymph node biopsy confirmed metastatic prostatic adenocarcinoma.<br /><br />This case highlights an unusual presentation of prostate cancer with unilateral upper extremity discoloration, likely related to cancer-associated thrombosis. Patients with malignancy are at significantly increased risk of thromboembolism, and the mechanism of paraneoplastic acrocyanosis may involve small-vessel thrombosis, hyperviscosity, and proliferation of cellular elements leading to ischemic skin changes.<br /><br />During hospitalization, the patient was treated with heparin for the extensive venous thrombosis and was later transitioned to oral anticoagulation. He was discharged in stable condition with outpatient oncology follow-up.

Asset Subtitle

Maria Riasat

Meta Tag

Author List Maria Riasat, Paulus Adinugraha

Category Clinical Vignettes

Concept Acrocyanosis

Concept Metastatic Castration-Resistant Prostate Cancer

Concept Malignancy

Concept Venous Thromboembolism

Concept Prostate-Specific Antigen

Distinguished Non-Finalist

Presenter Organization Mount Sinai Beth Israel

Presenting Author Maria Riasat

Track Adult

Keywords

prostate cancer

metastatic prostatic adenocarcinoma

supraclavicular mass

upper extremity discoloration

cancer-associated thrombosis

deep vein thrombosis

elevated PSA

lymphadenopathy

acrocyanosis

anticoagulation

Acrocyanosis

Metastatic Castration-Resistant Prostate Cancer

Malignancy

Venous Thromboembolism

Prostate-Specific Antigen