Small-cell Lung Cancer Presenting as Fatal Pulmonary Hemorrhage

Lim, Jun Hyeok; Ryu, Jeong-Seon; Cho, Sang Yong; Kim, Hyun-Jung; Jeon, Sang Hoon; Kim, Jung Soo; Nam, Hae-Seong; Cho, Jae Hwa; Kwak, Seung Min; Lee, Hong Lyeol

Hematological abnormalities including anemia, leukopenia, and thrombocytopenia are commonly observed due to the toxicity of anti-cancer therapy. However, hematologic abnormalities resulting from bone marrow metastasis and paraneoplastic phenomenon are not as common as those resulting from anti-cancer therapy [5, 6] . Severe thrombocytopenia developed rapidly and was refractory to platelet transfusion and dexamethasone administration. In addition, tests for anti-platelet antibody and anti-neutrophil cytoplasmic antibody were negative and anti-nuclear antibody was within normal range. These findings indicate that autoimmune disease was not likely to be the cause of thrombocytopenia [9] . Bone marrow examination is a diagnostic process for evaluating hematological abnormality or staging the disease. However, it rarely changes the stage [10] and bone marrow as an isolated metastatic site is found in fewer than 5% of SCLC patients [3] . Leukoerythroblastic reaction on peripheral blood smear is suggestive of bone marrow metastasis in the present case [11, 12] . Although bronchoscopy may be considered for localization or treatment in massive hemoptysis, it is contraindicated in a patient with severe thrombocytopenia [13] .