Thawani Rajat, Thomas Anna, Thakur Kshitij
Internal Medicine Resident, Maimonides Medical Center.
Internal Medicine, Crozer-Chester Medical Center, Upland, USA.
Cureus. 2018 Apr 3;10(4):e2419. doi: 10.7759/cureus.2419.
Tracheomediastinal fistula is a rare condition caused by multiple etiologies. We present a case of a patient of lung carcinoma receiving chemotherapy. A 63-year-old woman presented to the emergency room with a two-month history of worsening cough and shortness of breath. She was being treated with pemetrexed and bevacizumab for Stage IV non-small cell lung carcinoma. Chest X-ray showed a mass in the lung with mediastinal adenopathy. Computed tomography (CT) scan showed a perforation, confirmed with bronchoscopy. She had a secondary infection and she was started on intravenous antibiotics. The patient decided to continue care in a hospice. We present a rare complication of bevacizumab which has been only reported once in literature. Bevacizumab is known to cause tracheal fistulas when coupled with like invasive procedures. In our case, the patient developed a fistula without any invasive interventions. We advise that physicians using bevacizumab should be aware of the possibility of having such fistulas.
气管纵隔瘘是一种由多种病因引起的罕见病症。我们报告一例接受化疗的肺癌患者。一名63岁女性因咳嗽和气短加重两个月就诊于急诊室。她正在接受培美曲塞和贝伐单抗治疗IV期非小细胞肺癌。胸部X线显示肺部有肿块伴纵隔淋巴结肿大。计算机断层扫描（CT）显示有穿孔，经支气管镜检查得以证实。她发生了继发性感染，开始静脉使用抗生素。患者决定在临终关怀机构继续接受治疗。我们报告了贝伐单抗一种罕见的并发症，该并发症在文献中仅被报道过一次。已知贝伐单抗与类似的侵入性操作联合使用时会导致气管瘘。在我们的病例中，患者未进行任何侵入性干预就发生了瘘。我们建议使用贝伐单抗的医生应意识到发生此类瘘的可能性。
