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

On the seventh day, massive hemoptysis (≥ 200 mL per day) abruptly occurred and his dyspnea was rapidly aggravated to 8 of Borg scale. A chest CT scan revealed diffuse ground glass opacities and consolidation in both lung fields. Tranexamic acid and empirical broad-spectrum antibiotics including piperacillin-tazobactam, levofloxacin were initiated intravenously. Sputum gram stain and culture for bacteria and fungus revealed no organism. Sputum culture for adenovirus, parainfluenza virus, rhinovirus, respiratory syncytial virus, metapneumovirus, coronavirus, bocavirus, and enterovirus were negative. Antibody studies for Mycoplasma pneumoniae and rickettsia were negative, as was an antigen study for Streptococcus pneumoniae. His arterial blood gas study showed pH of 7.49, PaCO 2 of 28.7 mmHg, PaO 2 of 58.3 mmHg, HCO 3 22 mmol/L, and SpO 2 91 % on oxygen supplied via reservoir mask flow rate 15L/min. On the tenth day, he was intubated and ventilated mechanically. He rapidly deteriorated and died of respiratory failure on the twelfth day. His family did not want to have a postmortem examination, against physician's recommendation.