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Case Reports: Rare disease
Afatinib treatment of severe respiratory failure due to malignant lymphangitis in a dialysis patient with squamous cell carcinoma of the lung
  1. Osamu Kanai1,
  2. Mitsuteru Koizumi2,
  3. Takanori Ito1 and
  4. Tadashi Mio1
  1. 1Respiratory Medicine, National Hospital Organization Kyoto Medical Center, Kyoto, Japan
  2. 2Nephrology, National Hospital Organization Kyoto Medical Center, Kyoto, Japan
  1. Correspondence to Dr Osamu Kanai; okanai.kmc{at}gmail.com

Abstract

Patients on dialysis have limited treatment options for advanced lung cancer because some chemotherapeutic agents are unavailable due to renal dysfunction. A man in his 70s on peritoneal dialysis presented with persistent fever refractory to antibiotics for 2 weeks. Subsequent whole-body CT showed a 5 cm diameter mass in the right lower lobe of the lung with right-sided pleural effusion and osteolytic metastasis of the right iliac bone. The patient was diagnosed with squamous cell carcinoma (cT3N2M1b, stage IVB) harbouring the p.Gly719Ala point mutation on exon 18 of the epidermal growth factor receptor. The patient developed severe respiratory failure due to malignant lymphangitis after a bronchoscopy. He received 30 mg/day of afatinib, resulting in tumour shrinkage and recovery from respiratory failure. We advocate for aggressive screening of driver oncogenes in patients with lung cancer on dialysis, including those with squamous cell lung cancer.

  • Cancer intervention
  • Lung cancer (oncology)
  • Therapeutic indications
  • Dialysis

https://doi.org/10.1136/bcr-2022-253308

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    Footnotes

    • Contributors OK was responsible for drafting the text, sourcing and editing the clinical images, investigating the results, drawing the original diagrams and algorithms, and critically revising for important intellectual content. OK, MK, TI and TM gave final approval of the manuscript.

    • Funding This report was partiallly supported by the National Hospital Organization's fiduciary funds for Englis proofreading.

    • Case reports provide a valuable learning resource for the scientific community and can indicate areas of interest for future research. They should not be used in isolation to guide treatment choices or public health policy.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.