RATIONALE: Trousseau syndrome is a well-recognized paraneoplastic syndrome that manifests as thrombosis in patients with malignancies. It is particularly associated with mucin-producing adenocarcinomas and is known to lead to significant morbidity and mortality due to its thrombotic complications. The underlying mechanisms involve a hypercoagulable state induced by cancer-related factors, which necessitates vigilant monitoring and management.

PATIENT CONCERNS: In this case, we report a 53-year-old woman with endometrial cancer who experienced recurrent thrombotic events. Her background history included breast cancer and 5-months hypertension in drug treatment.

DIAGNOSES: Aging examination showed bilateral pulmonary artery thrombosis and multiple acute cerebral infarctions in both cerebral and cerebellar hemispheres. Laboratory examinations revealed an increased D-dimer level.

INTERVENTIONS: The patient was treated with rivaroxaban for anticoagulation for 1-month.

OUTCOMES: Cerebral infarction occurred again, and the D-dimer level increased again. After adjustment to low-molecular-weight heparin treatment, the patient's condition was stable, and no new infarction was found on follow-up brain magnetic resonance imaging.

LESSONS: This case underscores the complexities involved in managing thrombotic complications in patients diagnosed with Trousseau syndrome. It illustrates that thrombotic events may persist even with appropriate anticoagulant therapy, which can lead to a poor prognosis for affected patients. Nevertheless, it also emphasizes the importance of proactive monitoring and tailored management strategies, which can significantly reduce the incidence of thrombotic events and improve patient outcomes.