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

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}jichi.ac.jp
  • Accepted 5 August 2017
  • Published 7 September 2017

Summary

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.

Footnotes

  • 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: http://creativecommons.org/licenses/by-nc/4.0/

Open Access

Register for free content

The full text of all Editor's Choice articles and summaries of every article are free without registration

The full text of Images in ... articles are free to registered users

Only fellows can access the full text of case reports (apart from Editor's Choice) - become a fellow today, or encourage your institution to, so that together we can grow and develop this resource

Don't forget to sign up for content alerts so you keep up to date with all the case reports as they are published, and let us know what you think by commenting on the Editor's blog

Navigate This Article