Lung Cancer Initially Presenting with Diffuse Alveolar Damage and Brain Infarction: An Autopsy Case Report.
Taiki Ikeda, Yoshiaki Kinoshita, Masayo Yoshimura et al.
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Case in brief
A 67-year-old man presented with dyspnea, right hemiparesis, and dysarthria. Chest CT showed extensive pulmonary infiltrates and a small left upper-lobe nodule; brain MRI demonstrated multiple acute cerebral infarctions. He died from progressive respiratory failure despite comprehensive management. Autopsy identified pleomorphic lung carcinoma (pT1bN1M1c, pStage IVB), diffuse alveolar damage, and nonbacterial thrombotic endocarditis.
What made this case unusual
The cancer was initially suspected in the setting of simultaneous diffuse alveolar damage and cerebral infarction. Autopsy also found nonbacterial thrombotic endocarditis; the authors suggest a potential paraneoplastic link.
Diagnostic / clinical pearl
When extensive pulmonary infiltrates and acute cerebral infarctions occur together, an underlying malignancy may be considered, particularly when imaging also shows a pulmonary nodule; in this case, autopsy established the diagnosis.