Department of Pulmonary Medicine, Hakodate Goryoukaku Hospital, Hokkaido, Japan.
Department of Respiratory Medicine and Allergology, Sapporo Medical University School of Medicine, Sapporo, Japan.
Thorac Cancer. 2021 Nov;12(22):3072-3075. doi: 10.1111/1759-7714.14179. Epub 2021 Oct 6.
A 66-year-old man with squamous cell carcinoma had been receiving chemoradiation therapy after stereotactic radiotherapy for brain metastases. Atezolizumab was initiated as second-line therapy, after which the patient became progression- and recurrence-free. Four days after his second dose of tozinameran (BNT162b2, Pfizer-BioNTech), the patient developed persistent hemoptysis. The patient had no thrombocytopenia or coagulation abnormalities. Bronchoscopy revealed active bleeding from the left lingual tracheal branch. The patient was intubated and admitted to the intensive care unit because of increased bleeding. Subsequently, left bronchial artery embolization was performed using a Serescue. Hemostasis was achieved after the procedure, and the patient was discharged 7 days after the onset of hemoptysis. Vaccination against coronavirus disease has been reported to be associated with thrombosis and cerebral hemorrhage, and the hemoptysis in this case was suspected to be induced by vaccination. In summary, the benefits of vaccination exceeded the risks of adverse events in a patient with cancer. However, in conditions such as after chemoradiation, especially in patients with radiation pneumonitis wherein the vasculature is vulnerable, patients should be carefully monitored for hemorrhagic events after vaccination.
一位 66 岁男性患有鳞状细胞癌，在接受立体定向放射治疗脑转移后接受了放化疗。在接受替西木单抗（Atezolizumab）二线治疗后，患者无进展且无复发。在接受第二剂托珠单抗（BNT162b2，辉瑞-生物科技）治疗后 4 天，患者出现持续性咯血。患者无血小板减少或凝血异常。支气管镜检查显示左侧舌状气管分支有活动性出血。由于出血增加，患者进行气管插管并入住重症监护病房。随后，使用 Serescue 进行了左支气管动脉栓塞。手术后达到止血效果，患者在咯血发作后 7 天出院。有报道称，接种冠状病毒病疫苗与血栓形成和脑出血有关，本例患者的咯血疑似由疫苗接种引起。总之，在癌症患者中，接种疫苗的益处超过了不良事件的风险。然而，在放化疗等情况下，特别是在血管脆弱的放射性肺炎患者中，接种疫苗后应密切监测出血事件。
