Cotton Wool Spots as a Silent Manifestation of Trousseauʼs Syndrome

Background

Trousseauʼs syndrome is a paraneoplastic disorder that was described in 1865, by Armand Trousseau as migratory superficial thrombophlebitis [1]. Today, the term “Trousseauʼs syndrome” is often used to describe a hypercoagulation disorder in patients with malignancy. Those patients have a 4-to 7-fold higher risk of venous thromboembolic events than patients without cancer [2], [3]. Among cancer patients, 4 to 20 % have venous thromboembolism, which includes both deep venous thrombosis and pulmonary embolism [3], but disseminated intravascular coagulation (DIC) associated with non-bacterial thrombotic endocarditis can also be present, and arterial thrombosis can be found in 2–5 % of cases. The brain is frequently affected by arterial thrombosis in this pathology, because of the high concentration of thromboplastin (procoagulant), and the low concentration of thrombomodulin (anticoagulant) in cerebral vessels [3]. Pancreas is the primary tumor site in 10 % of Trousseauʼs syndrome [4].

Cotton wool spots (CWS) consist of an accumulation of axoplasmic debris resulting from inner retinal ischemia. We report the occurrence of CWS in a patient diagnosed with Trousseauʼs syndrome. To our knowledge such an association has not been reported yet.

• References

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