Acute Respiratory Failure Due to Paraneoplastic Syndrome Associated with Eosinophilic Pneumonia in a Patient with Seminoma: A Case Report

Case Report

J Fam Med. 2024; 11(4): 1363.

Acute Respiratory Failure Due to Paraneoplastic Syndrome Associated with Eosinophilic Pneumonia in a Patient with Seminoma: A Case Report

María Fernanda García-Aguilera1-3; Emerita Eugenia Basantes Borja3; Harold Anthony Alexander-León3; Luis Javier Unigarro Quiñonez2,3; Wendy Cristina Bonilla Poma2; Franklin Rigoberto Correa Álvarez2,3; Daniela Alejandra Ortiz Navas2,3; Nayely García-Méndez1

1Universidad de La Frontera, Doctorado en Ciencias Médicas. Temuco, Chile. Núcleo Milenio de Socio Medicina. Santiago, Chile

2Universidad Central del Ecuador, Facultad de Ciencias Médicas. Quito, Ecuador

3Hospital Oncológico SOLCA Núcleo de Quito. Quito, Ecuador

*Corresponding author: Nayely García Méndez, PhD Universidad de La Frontera, Doctorado en Ciencias Médicas, Francisco Salazar 1145, Temuco, Araucanía, Chile; Núcleo Milenio de SocioMedicina, Santiago, Chile. Email: [email protected]

Received: March 26, 2024 Accepted: April 26, 2024 Published: May 03, 2024

Abstract

Background: Acute eosinophilic pneumonia as a paraneoplastic syndrome is an infrequent finding, produces Acute Respiratory Distress Syndrome (ARDS) with a fatal outcome, and is associated with a poor oncological prognosis.

Case Summary: 27-year-old male patient with a history of weight loss three months before admission, asthenia, and night sweats; a month before lymphadenopathy in cervical, inguinal, and axillary lymph node chains, associated with a dry cough that progresses to moderate hemoptysis, with worsening of the symptoms, a requirement for home oxygen (3L), persistence of hemoptysis, and constitutional symptoms, went to the hospital.

The patient was admitted to the ICU with ARDS. After ruling out other pathologies, based on the clinical and tomographic findings, it is considered eosinophilic pneumonia.

Under treatment with corticosteroid therapy, the patient experiences an improvement in his clinical condition.

Conclusion: Acute respiratory failure associated with eosinophilic pneumonia and peripheral eosinophilia constitutes a complex clinical condition that requires diagnostic expertise to guarantee timely treatment. Although they respond favorably to treatment, the presence of these elements in the context of cancer is associated with an unfavorable prognosis.

Keywords: Acute eosinophilic pneumonia; Paraneoplastic syndrome; Paraneoplastic disorder; Respiratory failure; Pulmonary eosinophilia; Seminoma

Core Tip

Acute Respiratory Distress Syndrome (ARDS) caused by paraneoplastic eosinophilic pneumonia in the context of secondary immune response to cancer, especially in the case of seminoma, is an infrequent phenomenon. It manifests itself in both solid and hematological tumors, and its presence is linked to a dismal oncological prognosis. Diagnosing this condition presents significant challenges, requiring rapid and accurate identification to guarantee the prompt implementation of timely treatment. We present the first case of metastatic seminoma in a 23-year-old man admitted to the Intensive Care Unit (ICU) for respiratory failure-type severe ARDS due to eosinophilic pneumonia as the main symptom.

Introduction

Critical oncology patients have increased in recent years [1], and acute respiratory failure is one of the leading causes of admission to the Intensive Care Unit (ICU). It occurs less frequently in solid tumors at 15% [2]. Acute respiratory illness due to eosinophilic pneumonia is rare and of varying severity; it has been described as idiopathic or secondary depending on the presence or absence of a known underlying cause [3]. Identifiable causes include medications, infections, and tobacco exposure [3]. The pathogenesis is poorly known and is characterized by the infiltration of eosinophils into the alveoli and pulmonary interstitium, preserving the architecture. It was described for the first time by Allen et al. in 1989 as a febrile illness with diffuse pulmonary infiltrates and pulmonary eosinophilia [4].

Paraneoplastic syndromes are rare disorders that occur without a direct tumor invasion. Acute eosinophilic pneumonia as a paraneoplastic syndrome is an infrequent finding, produces Acute Respiratory Distress Syndrome (ARDS) with a fatal outcome, and is associated with a poor oncological prognosis [3]. It has been described in both solid and hematological tumors. We present the first case of metastatic seminoma in a 27-year-old man who was admitted to the ICU due to severe acute respiratory distress syndrome-type respiratory failure. The greatest challenge in cancer scenarios is timely diagnosis, which is of vital importance for early corticosteroid-based treatment.

This report aims to publicize a rare pathology in the field of cancer, following the CARE (Consensus-based clinical case report guideline development) writing guide for case reporting [5].

Case Presentation

Chief Complaints

A 27-year-old Ecuadorian male presented to the oncology clinic with persistent respiratory symptoms and constitutional symptoms.

History of the Present Illness

The persistence of hemoptysis and constitutional symptoms led him to the hospital, where he was additionally diagnosed with non-Hodgkin's lymphoma and received corticosteroid oral therapy for a month. He was referred to our health center for comprehensive management of his oncological pathology. On bronchoscopy, he presented acute hypoxemic respiratory failure, the need for invasive mechanical ventilation, and admission to the ICU.

History of Past Illness

Three months ago, with a history of weight loss, asthenia, and night sweats, a month before lymphadenopathy in cervical, inguinal, and axillary lymph node chains associated with a dry cough that progressed to moderate hemoptysis, he went to a doctor who considered starting antibiotic therapy (Ampicillin + Clarithromycin and later Levofloxacin) for 10 days, with worsening of the symptoms and a requirement for home oxygen (3L).

Personal and Family History

The patient denied any family history of malignant tumors.

Physical Examination

On physical examination, the vital signs were as follows: Body temperature 37°C; blood pressure 43/22 mmHg; mean arterial pressure 36 mmHg; heart rate: sinus tachycardia 110 beats per minute; 35 breaths per minute; hypoxemia PO2 40 mmHg; oxygen saturation 60%; crackles scattered in both lung fields. Initial mechanical ventilation parameters were FiO2 0.8, PEEP 8, PaO2/FiO2 50 mmHg.

Laboratory Examination

White blood cells are 36,420/μL, neutrophils 28,210/μL (77.6%), lymphocytes 3,330 /μL (9.1%), monocytes 1,510/μL (4.1%), eosinophils 2630/μL (7.3%), and basophils 180/μL (0.5%). Bronchoalveolar lavage (BAL) through the right middle lobe showed no eosinophils; we believe it is due to his previous corticosteroid treatment. The cytology of BAL fluid did not show malignant cells.

Imaging Examination

The chest x-ray showed disseminated reticulum-alveolar infiltrate in the two lung fields, basal (Figure 1). In the ultrasound hemodynamic assessment, ventricular interdependence is observed with a positive McConnell sign; dilated right ventricle, PSAP of 52 mmHg, and right heart failure was considered. In angiotomography of the chest (Figure 2), pulmonary thromboembolism was ruled out, as was an imaging pattern of micro-nodular lesions in the ground glass in both lung fields, mediastinal lymphadenopathy greater than 2 cm in regions 2R, 4R, 10R, and 7, conglomerates of mediastinal and hilar lymph nodes right, bilateral axillary, pulmonary micronodules, and bone blast lesions.