Sequential Bilateral Spontaneous Pneumothorax Following Gefitinib Therapy for Pulmonary Adenocarcinoma with Activated EGFR Mutation-A Case Report

Abstract

Spontaneous pneumothorax (SP) is a rare phenomenon in patients with primary and metastatic pulmonary neoplasm. Gefitinib has been approved as an effective treatment for pulmonary adenocarcinoma patients with an activated epidermal growth factor receptor (EGFR) mutation. Pneumothorax following gefitinib treatment is rarely reported in the literature. We present the case of a 49-year-old woman with primary pulmonary adenocarcinoma with bilateral lung, brain and multiple bone metastases. A L858R point mutation in exon 21 was detected by PCR/direct sequencing. She took gefitinib as her firstline chemotherapy, and had a partial response. Sequential bilateral SP developed after gefitinib had been used for about 2 months. We believe that the SP was caused by gefitinib therapy, which may have resulted in the necrosis of multiple pleural-based pulmonary nodules with bronchopleural fistula formation. This hypothesis is similar to that of SP following cytotoxic chemotherapy in sarcoma and germ cell tumor. We inserted a chest tube, but recurrence was found after its removal. Chemical pleurodesis was used, after which, the SP was no longer noted. In this report, we present a case of bilateral SP, which is a rare complication following gefitinib treatment for pulmonary adenocarcinoma. Chemical pleurodesis is recommended after the lung has been fully re-expanded to prevent repeated pneumothorax.