ARDS in a patient with lung cancer during postoperative adjuvant chemotherapy

Abstract

Background. Most outpatients receiving adjuvant chemotherapy for lung cancer show no severe neutropenia, and even though mild respiratory tract infection occurs, antibacterial treatment is usually effective. We report a patient who developed acute respiratory distress syndrome during adjuvant chemotherapy for lung cancer in absence of severe neutropenia. Case. A 68-year-old man who had received postoperative adjuvant chemotherapy with 3 cycles of carboplatin and paclitaxel visited our institution because of fever (38.0°C), progression of productive cough with purulent sputum. Chest computed tomography revealed a mild degree of interstitial changes around emphysematous lesions. Laboratory data showed a slight decrease of WBC (3300/mm3) and elevated C-reactive protein (6.43 mg/dl). On the day of admission, there were no symptoms about half an hour before, but he suddenly developed a fever of 38.9°C, dyspnea and pink frothy sputum. He was immediately treated with oxygen inhalation, but his oxygen saturation remained at 80-90%. He was transferred to the intensive care unit, underwent tracheal intubation, and was subsequently rescued from this crisis. Conclusion. Even if outpatients with chronic obstructive pulmonary disease receiving adjuvant therapy for lung cancer have no severe neutropenia, mild infection may trigger ARDS. Early detection and treatment are required for such patients. © 2008 The Japan Lung Cancer Society.