¹Resident in Internal Medicine Training, Department of Internal Medicine, Unidade Local de Saúde do Oeste – Hospital Caldas da Rainha, Caldas da Rainha, Portugal; ORCID: https://orcid.org/0000-0001-9503-7049.

²Resident in Internal Medicine Training, Department of Internal Medicine, Unidade local de Saúde do Alto Alentejo – Hospital de Portalegre, Portalegre, Portugal, ORCID: https://orcid.org/0000-0002-1994-7849.

³Senior Consultant in Internal Medicine, Casa Santa Maria (RNCCI/ERPI), Lisboa, Portugal; ORCID: https://orcid.org/0000-0003-4448-4169.

Corresponding Author: Sara Lourenço Tereso, ORCID: https://orcid.org/0000- 0001-9503-7049, Rua Diário de Notícias, 2500-176, Caldas da Rainha, Portugal.

Citation: Sara Tereso, Elisabete Mendes, Carlos Machado e Costa (2026). Acquired Hypofibrinogenemia as a Paraneoplastic Manifestation of Metastatic Prostate Adenocarcinoma. Euro J Case Rep Clin Imag. 2026; August, e22,1-3.

Copyrights: © Sara Lourenço Tereso, 2026, et al., This article is licensed under the Creative Commons Attribution-Non Commercial-4.0-International-License-(CCBY-NC) (https://europeanjournalofcasereports.com/blogpage/copyright-policy). Usage and distribution for commercial purposes require written permission.

Image Case Presentation:

A 73-year-old man presented with abdominal pain radiating to the lumbar region with a 3-day evolution, progressive weight loss (20 kg) over the previous year, and no history of trauma or falls. On examination, he had multiple spontaneous haematomas on the abdominal wall, left hand and right foot, at different stages of evolution (Figures 1A, 1B, & 1C). Laboratory tests showed mild bicytopenia, hypercalcaemia, normal amylase, marked hypofibrinogenaemia (81 mg/dL), prothrombin time 17.4 s, INR 1.7, D dimer 34.18 µg/dL, Factor X 36%, and Prostate Specific Antigen (PSA) 3640 µg/dL. Thoraco abdominopelvic computed tomography revealed diffuse osteolytic lesions suggestive of extensive metastasis and moderate prostatic enlargement with an asymmetric left sided protruding area. Transrectal prostate biopsy demonstrated acinar adenocarcinoma of the prostate, Gleason score 7. Based on the clinical and histological findings, and after excluding differential diagnoses, a diagnosis of acquired hypofibrinogenaemia as a paraneoplastic manifestation of metastatic prostate adenocarcinoma was established. He received fibrinogen concentrate for haemorrhagic prophylaxis and vitamin K for INR correction, without long term normalisation. One month after starting degarelix chemotherapy, fibrinogen levels normalised, PSA decreased and the haematomas regressed. Acquired hypofibrinogenaemia as a paraneoplastic manifestation is very rare, [1] typically described in patients with advanced disease at presentation, [2] particularly metastatic and associated with high grade prostate tumours [2]. Unexplained and exuberant haematomas should raise suspicion for acquired hypofibrinogenaemia, requiring early supportive treatment and targeted anti androgen therapy [1-3].

Declarations:

Funding: This research received no external funding.

Institutional Review Board Statement: Not applicable.

Informed Consent Statement: Informed consent for publication was obtained from the patient’s legal guardians.

Data Availability Statement: No new data were created or analyzed in this study. Data sharing is not applicable to this article.

Acknowledgments: Not applicable.

Conflicts of Interest: We confirm that there are no conflicts of interest to declare.

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2. Ong SY, Taverna J, Jokerst C, Enzler T, Hammode E, Rogowitz E. et al., Prostate Cancer-Associated Disseminated Intravascular Coagulation with Excessive Fibrinolysis treated with degarelix. Case reports in oncological medicine. 2015 Nov, 212543. DOI: 10.1155/2015/212543. 

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