A 63-Year-Old Man With Suspected Lung Cancer and Acute Renal Failure

Abstract

(CHEST 2003; 123:2140–2143) A 63-year-old man, a 100–pack-year smoker, presented with a 2-month history of cough, hoarse voice, anorexia, and weight loss. Radiologic studies showed a large, solid, left parahilar mass with mediastinal adenopathy (Fig 1). Bronchoscopy revealed paralysis of the left vocal cord, but was otherwise nondiagnostic on two occasions; “random” bronchial biopsies and cytology specimens were unremarkable. The patient rejected the suggestion of mediastinal exploration. Staging investigations were negative for metastatic disease. The patient started chemotherapy for suspected lung carcinoma. After three cycles of therapy, there was no radiologic response, and the patient went on to receive thoracic radiotherapy. During the course of this treatment, dizziness and mild ataxia developed; a brain CT scan showed multiple metastatic lesions not present 1 month earlier. The patient was given cerebral irradiation under corticosteroid cover. After radiotherapy, he continued to feel vaguely dizzy, especially when getting out of bed. Three weeks after completion of radiotherapy, he received a further course of chemotherapy with docetaxel and topotecan. Three days later, diffuse abdominal pain, weakness, and malaise developed, which progressed over 4 days and led to his hospital admission, 7 months after the original presentation.