SESSION TYPE: Miscellaneous Case Report Posters II
PRESENTED ON: Tuesday, October 23, 2012 at 01:30 PM - 02:30 PM
INTRODUCTION: We report the first case of lung cancer with concomitant capnocytophaga infection of the lung mass and mediastinal lymph nodes diagnosed by EBUS-TBNA with associated leukemoid paraneoplastic syndrome. We also highlight potential role of EBUS in diagnosing lung and mediastinal infections.
CASE PRESENTATION: A 62 year old white male with 47 PPY smoking history, h/o bladder cancer s/p chemoradiation presented with complaints of cough, shortness of breath, mild intermittent hemoptysis and generalized fatigue since 2 months. He had experienced 7 lbs weight loss and night sweats. CT Chest showed a left lower lobe 6x7 cm lung mass with bilateral hilar and mediastinal lymphadenopathy Suspecting possible infection, the patient was started on intravenous ampicillin-sulbactam. Endobronchial ultrasound guided real time sampling (EBUS-TBNA) of the lymph node stations R11, L11 and 4 and 7 as well as lung mass was performed. Biopsies were sent for cultures. He declined chemotherapy and was ultimately referred to hospice. RESULTS: WBC 34K, rest of blood counts and chemistry parameters were unremarkable. Sputum and blood cultures remained negative. Cultures from lymph node and lung mass grew copious amount of capnocytophaga species in aerobic media. Cell block examination of biopsy from all lymph node stations and lung mass revealed poorly differentiated lung cancer. Platelet count increased from 330 to 637 over 4 months. WBC remained high in spite of antibiotic treatment although he never developed progressive signs of infection.
DISCUSSION: To our knowledge, this is the first case of capnocytophaga infection involving mediastinal lymph nodes and lung mass Capnocytophaga is a gram negative rod which usually presents as sepsis and bacteremia in immunocompromised hosts, usually transmitted from dogs and cats. The leukocytosis was due to paraneoplastic syndrome, an entity often complicating adenocarcinoma of lung, thought to be due to increased production of granulocyte-monocyte colony stimulating factor by the malignant cells. This case also highlights the potential role of EBUS in diagnosing lung and mediastinal infections, particularly when other routine methods are unrevealing
CONCLUSIONS: This case is unique as its first reported case of capnocytophaga infection in lung mass and mediastinal lymph nodes, associated with leukemoid paraneoplastic syndrome and highights potential role of EBUS in diagnosing infections of lung and mediastinum.
1) Cooley, L. Capnocytophaga canimorsus: A Serious Infection Masquerading as a Serious Infection. Victorian Infectious Disease Bulletin, Sept 2001
2) Scully RE, Mark EJ, McNeely WF et al. Case records of the Massachusetts General Hospital. Weekly clinicopathological exercises. Case 20-1997. A 74-year-old man with progressive cough, dyspnea, and pleural thickening. N Engl J Med 1997;336:1895.903.
3) Capnocytophaga canimorsus Infections in human: review of the literature and cases report. Eur. J. Epidemiol. 1996
DISCLOSURE: The following authors have nothing to disclose: Amar Panchal, Yousef Shweihat, Ahmad Nusair
No Product/Research Disclosure InformationMarshall University, Huntington, WV