BMJ Case Reports 2017; doi:10.1136/bcr-2017-221032
  • Rare disease

Imatinib dramatically alleviates pulmonary tumour thrombotic microangiopathy induced by gastric cancer

Open Access
  1. Kazuomi Kario1
  1. 1Division of Cardiovascular Medicine, Department of Internal Medicine, Jichi Medical University, Shimotsuke, Tochigi, Japan
  2. 2Division of Cardiovascular Medicine, Sano-kosei General Hospital, Sano, Tochigi, Japan
  3. 3Division of Clinical Pharmacology, Department of Pharmacology, Jichi Medical University, Shimotsuke, Tochigi, Japan
  1. Correspondence to Dr Kana Kubota, r0911kk{at}
  • Accepted 5 August 2017
  • Published 7 September 2017


Pulmonary tumour thrombotic microangiopathy (PTTM) is a rare complication of cancer, which can be lethal due to progressive pulmonary hypertension (PH). Several case reports have demonstrated that imatinib, a platelet-derived growth factor receptor–tyrosine kinase inhibitor, can improve severe PH in patients with PTTM.

We describe the case of a 56-year-old woman. Her mean pulmonary arterial pressure (mPAP) was 47 mm Hg, and her dyspnoea worsened rapidly over several days. Although pulmonary embolism was not observed on CT, enlargement of the para-aortic lymph nodes was detected. Gastro-oesophageal endoscopy revealed signet-ring cell carcinoma. We diagnosed her as having PTTM based on her clinical course, and started treatment with imatinib. Five days after its administration, her mPAP decreased dramatically. She was discharged and lived without symptoms of PH until her death due to systemic metastasis of carcinoma. In some cases of PTTM, imatinib may be an effective therapeutic option for PH.


  • Contributors KK and TS were physicians in charge and wrote the manuscript. YI gave precise advice on medical treatment and refined the manuscript. KK supervised the aforementioned staffs and had responsibility for this case report.

  • Competing interests None declared.

  • Patient consent Detail has been removed from this case description/these case descriptions to ensure anonymity. The editors and reviewers have seen the detailed information available and are satisfied that the information backs up the case the authors are making.

  • Ethics approval Because imatinib therapy was off-label, we obtained urgent approval from the institutional ethics committee and received written informed consent from the patient for therapy itself as well as publication. The consent form written in Japanese is attached as PDF files.

  • Provenance and peer review Not commissioned; externally peer reviewed.

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:

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