The treatment with thalidomide is associated with an increased risk of thromboembolic events, in particular when it is combined with chemotherapy or dexamethasone. However, despite this well-documented prothrombotic effect, to our knowledge disseminated intravascular coagulation has never been reported in hematological or oncological patients treated with thalidomide. We report a case of disseminated intravascular coagulation in a patient treated with thalidomide and dexamethasone for advanced, heavily pretreated hormone-resistant prostate cancer in which a relationship with the treatment appears highly likely.