Metastatic extramammary Paget’s disease with pancytopenia and disseminated intravascular coagulation responding to weekly paclitaxel: a case report

Metastatic Extramammary Paget’s Disease (EMPD) is a rare cancer that currently has no validated treatment. Regimens including FECOM (5-FU, epirubicin, carboplatin, vincristine, and mitomycin C), trastuzumab in HER-2 expressing disease, 5-FU/cisplatin, or single agent docetaxel have been used in different case reports with varying levels of efficacy. A 58 year-old gentleman with EMPD diffusely metastatic to bone with bone marrow invasion presented with worsening shortness of breath and was found to have significant pancytopenia and disseminated intravascular coagulation (DIC). He was started on low-dose heparin for the DIC and weekly paclitaxel. Initially requiring daily transfusions of platelets and packed red blood cells, his shortness of breath improved after two doses of paclitaxel, and he became transfusion-independent after only three doses of paclitaxel. Carcinoembryonic Antigen (CEA) levels have been shown to correlate with tumor progression and parallel disease course. This patient’s pre-paclitaxel CEA of 62.1 ng/mL was also observed to decrease to 20.6 ng/mL after three doses. With no current validated chemotherapy regimen, this case can help guide consideration of paclitaxel in future treatment of metastatic EMPD. 

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