Extensive Deep Venous Thrombosis Associated with Chemotherapy for Testicular Cancer: A Case Report with Review of the Literature

The authors report a case of an extensive deep venous thrombosis occurring as a complication of chemotherapy with cisplatin, bleomycin and etoposide for a testicular germ cell tumour. During the first cycle of chemotherapy, the patient developed a dramatic picture of deep venous thrombosis, extending from the popliteal and iliofemoral veins up to the thoracic vena cava, close to the right atrium. Progression of thrombosis to the renal veins resulted in acute renal failure requiring dialysis. There are no reports in the literature of such an extensive thrombosis associated with this regimen. Of note, the remarkable results obtained with the early institution of thrombolytic therapy with streptokinase. Thromboembolic events are potentially lifethreatening complications that seem to occur more frequently than expected in patients receiving chemotherapy for germ cell tumours, in spite of young age. Preventive measures should not be overlooked in this setting. LIST OF ABBREVIATIONS GCT= germ cell tumours CMF= cyclophosphamide, 5-fluorouracil, methotrexate CMF/tam= cyclophosphamide, 5-fluorouracil, methotrexate, tamoxifen DVT= deep venous thrombosis BEP = bleomycin, etoposide, cisplatin TT= thrombolytic therapy DHL= lactate dehydrogenase β-hCG= human chorioninc gonadotropin β-subunit AFP= alphafetoprotein IV= intravenously RP= Raynaud phenomenon SH= systemic hypertension PVB= cisplatin, vinblastin, bleomycin FSH= follicle stimulating hormone LH= luteinizig hormone PTE= pulmonary thromboembolism