贝伐珠单抗维持治疗非放疗相关肺癌并发食管胸膜瘘

Bevacizumab-induced esophageal pleural fistula during maintenance therapy without radiation in lung cancer.

机构信息

Department of Respiratory Medicine, Xi'an People's Hospital (Xi'an No.4 Hospital), No.21 Jiefang Road, Xi'an, 710004, China.

Chest Clinic, NATA, Morang, Biratnagar, Nepal.

出版信息

BMC Pulm Med. 2021 Nov 25;21(1):384. doi: 10.1186/s12890-021-01750-w.

BACKGROUND

Esophageal pleural fistula (EPF) is a rare but fatal complication associated with bevacizumab use; however, cases reports of EPF caused by bevacizumab have not been previously published.

CASE PRESENTATION

A 66-year-old male patient diagnosed with stage IV lung adenocarcinoma on April 24, 2020 received 6 cycles of platinum-containing dual chemotherapy combined with bevacizumab followed by three cycles of bevacizumab monotherapy. Five days before admission, he experienced chest tightness, dyspnea, and right chest pain. Bed-side X-ray examination revealed a massive right hydrothorax, and food was found in the extracted pleural effusion. EPF was further confirmed by upper gastrointestinal radiography after oral administration of iohexol. The patient underwent jejunostomy as the distal esophagus could not be identified on gastroscopy, and eventually died of septic shock on January 16, 2021.

CONCLUSIONS

It is necessary to pay attention to EPF during bevacizumab use in patients with or without risk factors.

背景

食管胸膜瘘（EPF）是贝伐珠单抗治疗相关的一种罕见但致命的并发症；然而，此前尚未有贝伐珠单抗导致 EPF 的病例报告。

病例介绍

一名 66 岁男性患者于 2020 年 4 月 24 日被诊断为 IV 期肺腺癌，接受了 6 个周期含铂双化疗联合贝伐珠单抗治疗，随后又接受了 3 个周期贝伐珠单抗单药治疗。入院前 5 天，他出现胸闷、呼吸困难和右侧胸痛。床边 X 线检查显示大量右侧胸腔积液，抽出的胸腔积液中发现食物。口服碘海醇后行上消化道造影进一步证实为 EPF。由于胃镜无法识别远端食管，患者行空肠造口术，最终于 2021 年 1 月 16 日死于感染性休克。