Pulmonary tumor thrombotic microangiopathy diagnosed antemortem and treated with combination chemotherapy

Abstract

A 29-year-old man developed a persistent dry cough. Chest high-resolution computed tomography (HRCT) revealed centrilobular ultrafine granular shadows scattered in all lung fields. A lung biopsy with video-assisted thoracoscopic surgery revealed findings compatible with pulmonary tumor thrombotic microangiopa-thy (PTTM). However, the primary tumor was not identified. Combination chemotherapy with S-1 and cis-platin decreased his cough and improved the chest HRCT findings. The illness, however, gradually became difficult to control. He eventually developed pulmonary hypertension and died. Typically, an antemortem di-agnosis of PTTM cannot be made. In this case, the diagnosis of PTTM and combination chemotherapy im-proved the chest HRCT findings, respiratory symptoms, and prognosis. © 2012 The Japanese Society of Internal Medicine.