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Klin Monbl Augenheilkd 2017; 234(04): 541-542
DOI: 10.1055/s-0042-119687
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Georg Thieme Verlag KG Stuttgart · New York

Cotton Wool Spots as a Silent Manifestation of Trousseauʼs Syndrome

Cotton-Wool-Flecken als stilles Zeichen eines Trousseau-Syndroms
V. Kheir
Jules Gonin Eye Hospital, University of Lausanne, Switzerland
,
F. X. Borruat
Jules Gonin Eye Hospital, University of Lausanne, Switzerland
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Publication History

Publication Date:
01 February 2017 (online)

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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

  • 1 Trousseau A. Phlegmasia alba dolens. Clin Med Hotel Dieu Paris 1865; 3: 654-712
    PubMedGoogle Scholar
  • 2 Khorana AA, Francis CW, Culakova E. et al. Thromboembolism is a leading cause of death in cancer patients receiving outpatient chemotherapy. J Thromb Haemost 2007; 5: 632-634
    CrossrefPubMedGoogle Scholar
  • 3 Ikushima S, Ono R, Fukada K. et al. Trousseauʼs syndrome: Cancer-associated thrombosis. Jpn J Clin Oncol 2016; 46: 204-208
    CrossrefPubMedGoogle Scholar
  • 4 Sørensen HT, Mellemkaer L, Olsen JH. et al. Prognosis of cancers associated with venous thromboembolism. N Engl J Med 2000; 343: 1846-1850
    CrossrefPubMedGoogle Scholar
  • 5 McLeod D, Marshall J, Kohner EM. et al. The role of axoplasmic transport in the pathogenesis of retinal cotton-wool spots. Br J Ophthalmol 1977; 61: 177-191
    CrossrefPubMedGoogle Scholar
  • 6 Kohner EM. Cotton-wool spots in diabetic retinopathy. Proc R Soc Med 1969; 62: 1269-1271
    PubMedGoogle Scholar
  • 7 Wun T, White RH. Epidemiology of cancer-related venous thromboembolism. Best Pract Res Clin Haematol 2009; 22: 9-23
    CrossrefPubMedGoogle Scholar
  • 8 Stein PD, Beemath A, Meyers FA. et al. Incidence of venous thromboembolism in patients hospitalized with cancer. Am J Med 2006; 119: 60-68
    CrossrefPubMedGoogle Scholar