A Case of Occult Colon Cancer with Sepsis as the Primary Manifestation Identified by Bone Marrow Puncture

Background: Bone marrow metastasis is common in liver cancer and lung cancer, but there are few reports in colon cancer. To date, there are no research reports from mainland China; in particular, reports of bone marrow metastasis combined with septic shock as the main manifestation are even rarer. We hope that this case report can raise clinical awareness of the insidiousness of colon cancer and the possibility of metastasis to the bone marrow, especially for patients with progressive thrombocytopenia that is difficult to correct, should be treated differently from sepsis. Case presentation: A 71-year-old elderly woman presented with sepsis as the first symptom, which mainly manifested as high fever, low blood pressure, high inflammatory indicators, etc. CT examination revealed mild inflammation of the lungs and no obvious abnormalities in the abdomen. Blood culture suggested Escherichia coli and Aeromonas hydrophila/caviae . After anti-infective treatment, the patient's sepsis symptoms improved significantly, but after repeated platelet transfusion, her hypothrombosis had still not been corrected. Finally, a large number of malignant cells were identified through a bone marrow puncture smear, and further PET-CT examination confirmed that a malignant tumor in the ascending colon accompanied by multiple metastases, such as in the liver and bones. This patient was ultimately confirmed to have colon adenocarcinoma buy autopsy. Conclusions: : Colon cancer can have bone marrow metastasis, and it can be accompanied by intractable thrombocytopenia. Bone marrow aspiration may help distinguish between transient thrombocytopenia associated with sepsis.