EXTENSIVE BONE-MARROW NECROSIS AND THROMBOTIC MICROANGIOPATHY REVEALING DISSEMINATED ADENOCARCINOMA

BACKGROUND: Bone marrow necrosis and thrombotic microangiopathy are un commonly associated. We report an observation. CASE REPORT: A 52-year- old man with extensive bone marrow necrosis, associated with hemolytic microangiopathic anemia, was treated unsuccessfully with corticostero ids and plasmapheresis. Outcome was fatal. Autopsy showed disseminated bone marrow necrosis and medullary invasion by adenocarcinoma cells i n this patient operated 13 years earlier for gastric cancer. DISCUSSIO N: Extensive bone marrow necrosis or thrombotic microangiopathy can co mplicate usually advanced cancer. Prognosis is poor without response t o chemotherapy. Corticosteroids and plasma exchange are some times suc cessful. A relative efficacy of treatment with staphylococcal protein A immunopheresis is reported by several authors in thrombotic microang iopathy. (C) 1998, Masson, Paris.