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Reminder of important clinical lesson
Case report
A case of metastatic pancreatic adenocarcinoma confounded by complementary and alternative medicine therapies
  1. Ken M Stern1 and
  2. Bryan S Benn2
  1. 1 Division of Pulmonary Diseases and Critical Care Medicine, University of California Irvine Medical Center, Orange, California, USA
  2. 2 Division of Pulmonary and Critical Care Medicine, University of California Los Angeles, Torrance, California, USA
  1. Correspondence to Dr Ken M Stern, kmstern{at}uci.edu

Abstract

The use of complementary and alternative medicine (CAM) among cancer patients is widespread. Using these therapies may lead to treatment delays or confound the clinical picture when problems arise. Inquiry regarding CAM therapies used is an important part of a thorough history for any cancer patient. A 48-year-old man with a history of stage IV pancreatic adenocarcinoma was referred for a second opinion for a worsening dry cough in the setting of cavitary ground-glass opacities and non-cavitating nodules found on chest CT. Previous workup was non-diagnostic and his CT findings were atypical for pulmonary metastasis. Due to his extensive alternative therapy use, he was diagnosed with interstitial lung disease (ILD). Flexible bronchoscopy with transbronchial cryobiopsies revealed adenocarcinoma with intestinal/pancreatobiliary differentiation, consistent with metastatic pancreatic cancer. Adjacent alveolar parenchyma was without evidence of ILD. Atypical CT patterns of pulmonary metastasis should lead to an investigation regarding other possible causes.

  • vitamins and supplements
  • exposures
  • pancreatic cancer
  • interstitial lung disease

https://doi.org/10.1136/bcr-2019-231356

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    Footnotes

    • Contributors KMS was involved in drafting the case report. BSB was involved in the clinical expertise in revising for important intellectual content. All authors contributed to the conception, acquisition of data and interpretation of data. All authors read and approved the final manuscript.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

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

    • Patient consent for publication Obtained.