Paraneoplastički sindrom kao mogući uzrok plućne tromboembolije kod pacijentkinje sa nefrotskim sindromom

Abstract

A 59-year-old female patient was admitted to the hospital due to suffocation, lower leg swelling, and general weakness. She had been treated previously with immunosuppressive therapy for several years because of focal segmental glomerulosclerosis with nephrotic syndrome. The expected therapeutic response was not accomplished. Upon admission, the following were determined in the laboratory: hypoalbuminemia, hyperlipidemia and nephrotic range proteinuria. X-ray of the lungs showed bilateral pleural effusion, because of which a pleural puncture was performed and which drained 800 mL of fluid. Tumor markers test, breast echosonography and mammography were performed, along with bone scintigraphy, which was done upon the recommendation of an oncologist. Mammography described microcalcifications bilaterally while bone scintigraphy showed pathological accumulation of radiopharmaceuticals in the V thoracic vertebra and sternum corpus, and III and IV ribs on the left. On the fifth day of hospitalization, there was a deterioration of patient's general condition with hypotension, tachycardia and angina, as well as an increase in D-dimer. On the ECG sinus rhythm, f 80 / min, low voltage in standard and unipolar leads. Upon the recommendation of a cardiologist, CT was performed according to the program for pulmonary thromboembolism (PTE), which showed submassive PTE. Low molecular weight heparin therapy was used, along with oxygen therapy with dopaminergics, bronchodilators, human albumin and plasma infusions, statins and transient treatment of hypervolemia by means of hemodialysis. The patient was hospitalized for 61 days due to multiorgan dysfunction. Breast magnetic resonance imaging was not performed due to the poor general condition of the patient. Most likely it was breast cancer with secondary deposits, which was recognized late. PTE, as a probable consequence of paraneoplastic nephrotic syndrome, was diagnosed and treated in a timely manner.