A man who bled from his nose: A rare case of fatal myelophthisis as solitary manifestation of solid tumour

Massive bone marrow replacement by cancer cells is generally thought to be a late event, occurring after the diagnosis of the primary tumour, it has rarely been described as the first disease manifestation and never recorded as the final cause of death so far. We report the case of a 57 years-old presenting with massive nose bleeding, severe anaemia and thrombocytopenia. A18 mm-large roundish spot lesion in the right superior lobe with structured consolidation of the homolateral hilum, highly suggestive for primary lung cancer, was found on chest radiographs. Concurrently massive infiltration of the bone marrow by metastatic carcinoma was revealed. The patient immediately received transfusion therapy, but, despite supportive care, he got worse and, after several episodes of bleeding, he died in the afternoon of the third admission day. In the light of the available literature and after an overview of differential diagnostic hypothesis, fatal myelophthisis as a solitary manifestation of carcinoma is discussed. It can be concluded that marrow smears should be carefully scrutinized for tumour cells in patients with abnormal blood counts and that clinicians should be aware of the possibility of such atypical solid tumour presentation.