Kai Yoshiro, Ohara Hiroya, Matsuda Masayuki, Shimizu Hironori, Park Hun Soo, Myouchin Kaoru, Kikutsuji Naoya, Hontsu Shigeto, Yamauchi Motoo, Yoshikawa Masanori, Muro Shigeo
Department of Respiratory Medicine, Minami-Nara General Medical Center, 8-1 Fukugami, Oyodo-cho, Yoshino-gun, Nara, 638-8551, Japan.
Department of Neurology, Minami-Nara General Medical Center, 8-1 Fukugami, Oyodo-cho, Yoshino-gun, Nara, 638-8551, Japan.
Respir Med Case Rep. 2021 Oct 23;34:101531. doi: 10.1016/j.rmcr.2021.101531. eCollection 2021.
We describe a case of Trousseau's syndrome in a patient with lung carcinoma. A 69-year-old man presented with pleural effusion. Further evaluation revealed EGFR mutation-positive non-small cell carcinoma in the upper lobe with extensive lymph node, bone, and brain metastases. Administration of osimertinib, an EGFR tyrosine kinase inhibitor, resulted in partial tumor response, but caused osimertinib-induced pneumonitis 10 weeks later. Prednisolone restrained lung injury progression and was gradually tapered. However, he presented with impaired consciousness and right hemiplegia. Magnetic resonance imaging revealed a left middle cerebral artery M1 segment occlusion. D-dimer level was elevated to 19.5 μg/mL. In the absence of atherosclerotic or cardiogenic thrombi, these findings led to the diagnosis of Trousseau syndrome. Endovascular therapy, but not tissue plasminogen activator, improved his condition with no recurrences. These treatment strategies are crucial to restore function in patients with potentially disabling cerebral infarction due to Trousseau syndrome.
我们描述了一例肺癌患者的特鲁索综合征。一名69岁男性因胸腔积液就诊。进一步评估发现上叶表皮生长因子受体（EGFR）突变阳性的非小细胞癌，并伴有广泛的淋巴结、骨和脑转移。给予EGFR酪氨酸激酶抑制剂奥希替尼后，肿瘤出现部分缓解，但10周后引发了奥希替尼所致的肺炎。泼尼松抑制了肺损伤进展，且剂量逐渐减少。然而，他随后出现意识障碍和右侧偏瘫。磁共振成像显示左侧大脑中动脉M1段闭塞。D-二聚体水平升高至19.5μg/mL。在没有动脉粥样硬化或心源性血栓的情况下，这些发现导致了特鲁索综合征的诊断。血管内治疗而非组织纤溶酶原激活剂改善了他的病情，且未复发。这些治疗策略对于恢复因特鲁索综合征导致潜在致残性脑梗死患者的功能至关重要。
