Pulmonary tumour thrombotic microangiopathy mimicking immunotherapy-associated pneumonitis.
Hayley McKenzieDeborah ScottAdrian C BatemanHugo De La Pena GomezPublished in: BMJ case reports (2023)
We present a case of pulmonary tumour thrombotic microangiopathy (PTTM) in a patient on adjuvant immunotherapy for resected triple negative breast cancer. The patient presented with deranged liver function tests and subsequently developed severe hypoxia and thrombocytopaenia, with right heart failure. The primary differential diagnosis considered was immunotherapy-associated hepatitis and pneumonitis. Despite organ support, the patient deteriorated rapidly and died of respiratory failure. As is often the case with PTTM, the diagnosis was only found at postmortem. PTTM should be considered in patients with a background of cancer (and may be more common in certain subtypes) who present with this unusual combination of clinical features. While the condition carries an extremely poor prognosis, prompter recognition for future patients may allow consideration of novel treatments.
Keyphrases
- poor prognosis
- heart failure
- case report
- respiratory failure
- end stage renal disease
- pulmonary hypertension
- long non coding rna
- ejection fraction
- newly diagnosed
- chronic kidney disease
- extracorporeal membrane oxygenation
- papillary thyroid
- peritoneal dialysis
- rheumatoid arthritis
- left ventricular
- intensive care unit
- squamous cell carcinoma
- early onset
- young adults
- systemic sclerosis
- atrial fibrillation
- current status
- acute respiratory distress syndrome