Hussain Akbar, Prevatt Opal, Piercy Jonathan, Ahmed Nazneen, Marlowe Stanley, Damaa Georges
Internal Medicine, Appalachian Regional Healthcare, Harlan, USA.
Cureus. 2023 Aug 24;15(8):e44047. doi: 10.7759/cureus.44047. eCollection 2023 Aug.
This case report presents a late middle-aged man with a right infra-hilar lung mass and pericardial effusion (PE). The patient was diagnosed with metastatic small-cell lung carcinoma, with metastases to the liver, pancreas, and cerebellum. The pericardial fluid cytology confirmed the presence of malignant cells most compatible with non-small-cell carcinoma. The patient received carbo/etoposide chemotherapy, and his treatment plan included adding atezolizumab and radiation therapy. Despite the excellent efficacy of immunotherapy, immune-related adverse events (IRAEs), including cardiac toxicity, were noted in some patients. PE related to immune checkpoint inhibitor (ICI) use is rare but potentially severe. This case highlights the importance of vigilant monitoring for cardiovascular symptoms during immunotherapy and the significance of pericardial fluid analysis in diagnosing malignant pericardial disease. Prompt diagnosis and appropriate treatment can lead to improved patient outcomes in cases of lung cancer-associated cardiac complications.
本病例报告介绍了一名中老年男性，患有右肺门部肿块和心包积液（PE）。该患者被诊断为转移性小细胞肺癌，已转移至肝脏、胰腺和小脑。心包液细胞学检查证实存在与非小细胞癌最相符的恶性细胞。患者接受了卡铂/依托泊苷化疗，其治疗方案包括加用阿替利珠单抗和放射治疗。尽管免疫疗法疗效显著，但部分患者出现了包括心脏毒性在内 的免疫相关不良事件（IRAEs）。与免疫检查点抑制剂（ICI）使用相关的PE罕见但可能很严重。本病例强调了免疫治疗期间对心血管症状进行密切监测的重要性，以及心包液分析在诊断恶性心包疾病中的意义。对于肺癌相关心脏并发症，及时诊断和适当治疗可改善患者预后。
