Trousseau Syndrome Manifesting as Recurrent Embolic Stroke in ROS1-Positive Non-Small-Cell Lung Cancer: A Case Report

Background: Trousseau syndrome is a paraneoplastic hypercoagulable state manifesting as recurrent thromboembolism. Lung adenocarcinomas harboring specific driver mutations, such as ROS1 rearrangements, are associated with a significantly increased risk of these events and related complications. Case presentation: A 61-year-old non-smoking female with stage IV ROS1-positive lung adenocarcinoma developed bilateral cerebral and cerebellar infarctions. While aspirin therapy was initiated, she still experienced a recurrent ischemic stroke involving the left middle cerebral artery, leading to a diagnosis of Trousseau syndrome. However, the course was further complicated by pneumonia and respiratory failure. Anticoagulation with apixaban was initiated. A third embolic event subsequently occurred, involving a right middle cerebral artery occlusion with associated subarachnoid hemorrhage and hemorrhagic transformation. Despite intensive management, the patient’s condition deteriorated, and she passed away. Conclusions: Trousseau syndrome significantly impairs the prognosis of lung cancer patients, especially with specific driven genes, such as ROS-1 gene re-arrangement. This case highlights the deteriorating prognosis of cancer-associated thrombosis, which can be refractory and requires heightened clinical vigilance.