Hemorrhagic disseminated intravascular coagulation after 177Lu-Dotatate in metastatic midgut neuroendocrine tumor: A case report.

RATIONALE Peptide receptor radionuclide therapy with 177Lu-Dotatate represents a major breakthrough in the treatment of metastatic well differentiated neuroendocrine tumors. This treatment is generally well tolerated. Reported severe long-term hematological side effects are rare and include hematopoietic neoplasms and bone marrow failure. PATIENTS CONCERNS We describe the case of a patient presenting spontaneous bleeding and bruising occurring 6 weeks after the first administration of 177Lu-Dotatate. Blood tests showed anemia, thrombocytopenia, prolonged clotting times, profound fibrinolysis and low levels of coagulation factors II and V. There were no signs of tumor lysis syndrome. DIAGNOSES We made the diagnosis of acute disseminated intravascular coagulation. INTERVENTION Treatment consisted of multiple transfusions of fresh frozen plasma, fibrinogen and platelets, and corticosteroids. Acute disseminated intravascular coagulation (DIC) persisted for 10 days and then resolved. OUTCOMES Metabolic imaging 5 months after the 177Lu-Dotatate administration showed disease progression. Treatment with 177Lu-Dotatate was not rechallenged due to the occurrence of DIC. LESSONS Our case suggests that acute hemorrhagic disseminated intravascular coagulation can be a rare and life-threatening subacute side effect of 177Lu-Dotatate peptide receptor radionuclide therapy.