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Lung Cancer: Global Case Report Poster - Lung Cancer |

Esophageal Ulcer and Fistula in a Patient With Advanced Adenocarcinoma of Lung Received Bevacizumab

Ching-Min Tseng, MD; Mei-Yin Chen, MD; Tao Chi-Wei, MD
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Cheng Hsin General Hospital, Taipei, Taiwan


Copyright 2016, American College of Chest Physicians. All Rights Reserved.


Chest. 2016;150(4_S):692A. doi:10.1016/j.chest.2016.08.787
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SESSION TITLE: Global Case Report Poster - Lung Cancer

SESSION TYPE: Global Case Report Poster

PRESENTED ON: Tuesday, October 25, 2016 at 01:30 PM - 02:30 PM

INTRODUCTION: We reported a lung cancer patient who reveived bevaizumab suffered from esophageal ulcer and progressed developing an esophageal fistula.

CASE PRESENTATION: A 48 year-old male, who had hypertension and hyperlipidemia, developed the adenocarcinoma of lung with mediastinal lymph adenopathy. Initially he received right upper lobe lobectomy on September, 2010. The pathological staging was pT1bN2M0, stage IIIA. Then he started on adjuvant chemotherapy consisting of docetaxel and cisplatin for 4 cycles. Chest computed tomography (CT) for restaging showed stable disease. However, he presented with productive cough, chest pain, dyspnea and left leg painful swelling 8 months later. Chest CT and limb sonography revealed extensive thrombosis in pulmonary artery, left femoral, bilateral popliteal, peroneal, posterior tibial and lower calf veins. We gave anti-coagulant agent with warfarin and chemotherapy consisted of pemetrexed, cisplatin and bevacizumab for deep vein thrombosis with pulmonary embolism, suspect malignancy related. After 4 cycles, he complained progressive painful swallowing and severe chest pain and tarry stool after the 5th cycle. The endoscope found a large, longitudinal ulcer with irregular margin and scattered bleeding spots in middle third of esophagus.(Figure 1) It supposed that these lesions were related to bevacizumab treatment, since there were no known factors associated with the esophageal ulcer. He was started with intravascular esomeprazole. The pathology report showed no evidence of malignancy. Unfortunately, his symptoms progressed and fever flared up. The result of esophagography showed a blind-ended fistula tract in the right posterior wall of middle third esophagus.(Figure 2) It showed no communication with the trachea or pericardium recess. He was fasted and started on empiric antibiotics piperacilline and tazobactem administration due to sepsis. Afterward he received feeding jejunostomy to bypass the esophageal fistula. He recovered and improved 4 weeks later after supportive treatment and jejunostomy

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