Pulmonary Tumor Thrombotic Microangiopathy Diagnosed Antemortem and Treated with Combination Chemotherapy

Hiroe Kayatani; Kiyoshi Matsuo; Yusuke Ueda; Mizuho Matsushita; Keiichi Fujiwara; Toshiro Yonei; Ichiro Yamadori; Hisayuki Shigematsu; Akio Andou; Toshio Sato

doi:10.2169/internalmedicine.51.7682

CASE REPORTS

Pulmonary Tumor Thrombotic Microangiopathy Diagnosed Antemortem and Treated with Combination Chemotherapy

Hiroe Kayatani, Kiyoshi Matsuo, Yusuke Ueda, Mizuho Matsushita, Keiichi Fujiwara, Toshiro Yonei, Ichiro Yamadori, Hisayuki Shigematsu, Akio Andou, Toshio Sato

Author information

Hiroe Kayatani
Department of Respiratory Medicine, National Hospital Organization Okayama Medical Center, Japan
Kiyoshi Matsuo
Department of Respiratory Medicine, National Hospital Organization Okayama Medical Center, Japan
Yusuke Ueda
Department of Respiratory Medicine, National Hospital Organization Okayama Medical Center, Japan
Mizuho Matsushita
Department of Respiratory Medicine, National Hospital Organization Okayama Medical Center, Japan
Keiichi Fujiwara
Department of Respiratory Medicine, National Hospital Organization Okayama Medical Center, Japan
Toshiro Yonei
Department of Respiratory Medicine, National Hospital Organization Okayama Medical Center, Japan
Ichiro Yamadori
Department of Clinical Pathology, National Hospital Organization Okayama Medical Center, Japan
Hisayuki Shigematsu
Department of Chest Surgery, National Hospital Organization Okayama Medical Center, Japan
Akio Andou
Department of Chest Surgery, National Hospital Organization Okayama Medical Center, Japan
Toshio Sato
Department of Respiratory Medicine, National Hospital Organization Okayama Medical Center, Japan

Keywords: pulmonary tumor thrombotic microangiopathy, cancer of unknown primary, pulmonary hypertension, combination chemotherapy

JOURNAL OPEN ACCESS

2012 Volume 51 Issue 19 Pages 2767-2770

DOI https://doi.org/10.2169/internalmedicine.51.7682

Details

Abstract

A 29-year-old man developed a persistent dry cough. Chest high-resolution computed tomography (HRCT) revealed centrilobular ultrafine granular shadows scattered in all lung fields. A lung biopsy with video-assisted thoracoscopic surgery revealed findings compatible with pulmonary tumor thrombotic microangiopathy (PTTM). However, the primary tumor was not identified. Combination chemotherapy with S-1 and cisplatin decreased his cough and improved the chest HRCT findings. The illness, however, gradually became difficult to control. He eventually developed pulmonary hypertension and died. Typically, an antemortem diagnosis of PTTM cannot be made. In this case, the diagnosis of PTTM and combination chemotherapy improved the chest HRCT findings, respiratory symptoms, and prognosis.

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