Sunitinib Induced Disseminated Intravascular Coagulation after COVID-19 Infection in a Patient with Neuroendocrine Tumor: A Case Report

Disseminated intravascular coagulation (DIC) is a known complication of malignancy. Drug-induced DIC is also reported. Sunitinib is a tyrosine kinase inhibitor approved as an oral targeted therapy in the treatment of different cancers. Here we present a case study of disseminated intravascular coagulation following the administration of Sunitinib after COVID-19 infection in a patient diagnosed with metastatic neuroendocrine tumor of the lung. A 35-year-old male patient with a known metastatic lung neuroendocrine tumor (NET) who was treated with Sunitinib for many years with partial response and tolerating the treatment well-developed recurrent DIC on Sunitinib after COVID-19 infection. COVID-19 infection is reported to be associated with endothelial injury and inflammation. Vascular endothelial growth factor (VEGF) receptors have a role in the protection and modulation of endothelium. Sunitinib is a multikinase inhibitor with anti- VEGF effect. It is possible that endothelial injury after COVID-19 may have triggered recurrent DIC in this patient who had previously tolerated the same drug without problems. DIC may be underreported especially with antineoplastics having anti-VEGF effects. Potential risk, interaction, and association with COVID-19 infection in the Era of the pandemic are unclear but warrants further research, and drug-induced DIC should be considered in the differential diagnosis of such cases.