Lung Cancer: Student/Resident Case Report Poster - Lung Cancer I |

ARDS With Peripheral and Bronchoalveolar Lavage Eosinophilia as an Initial Presentation for Disseminated Small Cell Lung Cancer FREE TO VIEW

Carissa Monterroso, MD; Bryden Considine, DO; Phyllis Schatz, MD
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University of Conneticut, Hartford, CT

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

Chest. 2016;150(4_S):743A. doi:10.1016/j.chest.2016.08.838
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SESSION TITLE: Student/Resident Case Report Poster - Lung Cancer I

SESSION TYPE: Student/Resident Case Report Poster

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

INTRODUCTION: Peripheral eosinophilia has been associated with neoplastic diseases although less commonly with solid tumors. The clinical significance of peripheral eosinophilia associated with malignancy has not been well established. We have found no reports of ARDS with bronchoalveolar eosinophilia described as an initial presentation of SCLC.

CASE PRESENTATION: A 57 year old male presented with dyspnea and cough for 2 days. He had experienced malaise for 1-2 weeks, with fever to 101 F. His history was significant for MI, GERD and 50 pack year smoking history. On admission he had O2 saturations of 78% and chest x-ray revealing bilateral pulmonary edema. Labs showed a WBC count of 9200 cells/mm3 with an eosinophilia of 18.9%. He quickly decompensated, was intubated with repeat CXR consistent with ARDS. CTA showed hilar and mediastinal lymphadenopathy with emphysema and extensive ground-glass changes. Bronchoscopy demonstrated 24% eosinophils on BAL. No evidence of infectious etiology was found and cytology was negative. He was treated with IV steroids for a suspected acute eosinophilic pneumonia with initial improvement. Unfortunately, he decompensated due to VAP and ARF. No other etiology was found for his eosinophilia. Ultimately, a bone marrow biopsy revealed metastatic poorly differentiated neuroendocrine small cell of pulmonary origin. He continued to decline and goals of care were shifted to comfort focus. An autopsy revealed widely disseminated SCLC of the left lung with metastases to the pleura, hilar lymph nodes, right pleura, right lung, bone marrow, adrenals, left kidney, thoracic and paraaortic lymph nodes.

DISCUSSION: Peripheral eosinophilia associated with solid tumor malignancy is rare, with one report of SCLC which was limited to a peripheral eosinophilia without ARDS. Studies describe evidence of eosinophilic chemotactic factor demonstrated in tumor extracts along with production of eosinophilic colony stimulating factor (Eo-CSF) and eosinophilic chemotactic factor (ECF). In the case described above, ARDS along with peripheral and BAL eosinophilia were demonstrated without other cause.

CONCLUSIONS: We postulate that tumor cells releasing cytokines resulting in eosinophilia also incited acute lung injury with ARDS which has not previously been described. Although rare, this case warrants further investigation on the clinical relevance of eosinophilia in malignancy.

Reference #1: Kodama T, et al. Large cell carcinoma of the lung associated with marked eosinophilia. Cancer 54: 2313.1984.

Reference #2: Verstraeten AS, et al: Excessive eosinophilia as paraneoplastic syndrome in a patient with non-small-cell lung carcinoma: a case report and review of the literature. Acta Clin Belg 66:293-297, 2011

Reference #3: Niamut SM1, et al: Eosinophilia caused by solid malignancy. Ned Tijdschr Geneeskd. 2004 Sep 18;148(38):1883-6.

DISCLOSURE: The following authors have nothing to disclose: Carissa Monterroso, Bryden Considine, Phyllis Schatz

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