Pancreatic cancer initially presenting with acute renal infarction: A case report

BACKGROUND: Pancreatic carcinoma is recognized as one of the most prothrombotic malignancies, carrying a high risk of thrombotic events, which may even precede the diagnosis of the underlying occult tumor. Acute renal infarction (ARI) as the initial presenting feature in patients with pancreatic cancer is a rare occurrence, and misdiagnosis is common during early evaluation. CASE SUMMARY: We report a patient who presented with ARI as the initial manifestation prior to the diagnosis of pancreatic cancer. The 50-year-old male was admitted to our emergency department with sharp, left-sided abdominal pain and was subsequently transferred to our department following the detection of a pancreatic space-occupying lesion on computed tomography (CT). CT angiography promptly identified the cause of his pain, confirming right renal infarction. Urgent interventional treatment was initiated to alleviate symptoms and restore renal perfusion. Despite aggressive thrombolytic and anticoagulant therapy, the thrombotic event rapidly worsened, leading to multiple cerebral infarctions. The patient's condition ultimately deteriorated under palliative care. CONCLUSION: This case illustrates that arterial thromboembolism, when diagnosed at an advanced stage of pancreatic cancer, appears to be a terminal event that portends a poor prognosis. Establishing an arterial thrombosis prediction model will potentially identify the profile of high-risk patients with thrombotic consequences for primary prevention.