Case Report
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Mar 26, 2022; 10(9): 2969-2975
Published online Mar 26, 2022. doi: 10.12998/wjcc.v10.i9.2969
Occult colon cancer with sepsis as the primary manifestation identified by bone marrow puncture: A case report
Hua-Jun Wang, Chen-Jie Zhou
Hua-Jun Wang, Chen-Jie Zhou, Department of Critical Care Medicine, The Affiliated People's Hospital of Ningbo University, Ningbo 315040, Zhejiang Province, China
Author contributions: Wang HJ was responsible for preparing the paper and providing final approval; Zhou CJ was responsible for acquiring, analyzing, and interpreting data and critically revised the paper for important intellectual content; all authors have read and approved the manuscript.
Informed consent statement: Informed written consent was obtained from the patient for the publication of this report and any accompanying images.
Conflict-of-interest statement: The authors declare that they have no conflict of interest.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Hua-Jun Wang, MD, Doctor, Department of Critical Care Medicine, The Affiliated People's Hospital of Ningbo University, No. 251 Baizhang Road, Ningbo 315040, Zhejiang Province, China. whj269696@163.com
Received: November 21, 2021
Peer-review started: November 21, 2021
First decision: December 27, 2021
Revised: January 4, 2022
Accepted: February 10, 2022
Article in press: February 10, 2022
Published online: March 26, 2022
Processing time: 121 Days and 2.8 Hours
Abstract
BACKGROUND

Bone marrow metastasis is common in liver and lung cancer, but there are few reports on bone marrow metastasis in colon cancer. To date, there are no such reports from mainland China, and reports of bone marrow metastasis with septic shock as the main manifestation are even rarer.

CASE SUMMARY

A 71-year-old woman with sepsis as the first symptom presented with high fever, low blood pressure and high inflammation indicators. Computed tomography (CT) examination revealed mild inflammation of the lungs and no obvious abnormalities in the abdomen. Blood culture suggested Escherichia coli, Aeromonas hydrophila and Aeromonas caviae infection. Antibiotic treatment significantly improved the patient’s sepsis symptoms; however, her thrombocytopenia (TCP) could not be corrected despite repeated platelet transfusions. Many malignant cells were ultimately found following a bone marrow puncture smear, and further positron emission tomography/CT (PET/CT) examination confirmed that the malignant tumor in the ascending colon was accompanied by multiple metastases, including the liver and bones. Colon adenocarcinoma was confirmed by autopsy.

CONCLUSION

Patients with advanced colon cancer may not have typical clinical symptoms, and sepsis may be the first symptom. When patients have severe TCP that cannot be explained by sepsis of intestinal origin, it is necessary to be aware of the possibility of bone marrow metastasis of intestinal tumors. As such patients often cannot tolerate endoscopy, bone marrow biopsy smears or biopsy tests for specialized cells can help obtain a diagnosis, especially in less developed countries where PET/CT is scarce.

Keywords: Bone marrow metastasis; Colon cancer; Bone marrow puncture; Case report

Core Tip: Colon cancer symptoms are often not obvious, and the incidence of secondary bone marrow metastasis is low. Once secondary intestinal sepsis and refractory thrombocytopenia occur, bone marrow aspiration can help confirm the diagnosis promptly.