872: UNCOMMON PRESENTATION OF A RARE NEOPLASM: AN ENDOBRONCHIAL PAPILLOMA PRESENTING AS SEPSIS

Abstract

Introduction: Endobronchial papilloma’s (EBP) are rare neoplasms associated with nicotine use and Human Papilloma Virus (HPV). We present a case of a non-smoking, HPV negative male who presented to the hospital with obstructive pneumonia and sepsis due to a lower respiratory tract EBP. Description: A 75-year-old male presented to his primary care doctor with two weeks of dyspnea and productive cough. He was a non-smoker and presented with a medical history of end stage renal disease on hemodialysis, and atrial fibrillation (AF). At his primary care doctor’s office, he was found to be hypoxic and sent to the Emergency Department for further evaluation. Computed tomography-pulmonary angiogram revealed complete atelectasis of his left upper lobe, with consolidation present of the left lower lung. This raised suspicion for an intra-bronchial lesion and pneumonia. Ceftriaxone and azithromycin were initiated, and the patient underwent video fiberoptic white light bronchoscopy. Findings were notable for a lesion completely obstructing the anterior, apical, and posterior segments of the left upper lobe. The lesion was excised, and multiple biopsies were obtained. Pathology revealed glandular papilloma with chronic inflammation. HPV serotyping for 16, 18, 31, 33, and 51 were negative. The patient was kept on a ventilator post-operatively due to hypercapnia and uncontrolled AF. He was extubated less than 24 hours later. He was discharged home with oral cefdinir for 14 days, and 2 L/min of oxygen. He followed up with his pulmonologist one week later in clinic, recovering well, and without complication. Discussion: EBP are benign neoplasms, which represent less than 1% of all lung tumors. Due to their slow growing nature, they primarily present with chronic respiratory symptoms such as exertional dyspnea or cough. This case represents an uncommon presentation of EBP, specifically sepsis. Our patient did not have classic risk factors such as HPV or smoking history. Although rare, clinicians should keep EBP in mind when patients present with sepsis if endobronchial lesions are suspected.