Reactions 1680, p82 - 2 Dec 2017
Tracheoesophageal fistula: case report
A 72-year-old man developed tracheoesophageal fistula
following treatment with carboplatin and gemcitabine [routes
and dosages not stated].
The man, who had a history of stage IV squamous lung
cancer, was hospitalised with four week history of shortness of
breath, anorexia and increased haemoptysis. He was
diagnosed with lung cancer eight years ago and was treated
with combined radiation and chemotherapy leading to
progression-free seven years. However, the cancer reoccurred
one year ago. He was treated with four cycles of palliative
chemotherapy consisting of carboplatin and gemcitabine.
However, one month before the current hospitalisation, he
developed pain in right side of chest, progressive haemoptysis
and fatigue. After hospitalisation, chest X-ray was taken, which
revealed left lung base with worsened reticular markings
indicating an infection. The chest CT findings were suggestive
of an interval progression of malignancy with an area of
consolidation along the medial right lower lung. Sputum
culture revealed mixed bacterial growth [duration of treatment
to reaction onset not clearly stated].
The man was treated with antibacterials and palliative
radiation therapy. Immediately after completion of eight cycles
of radiation therapy, the man developed shortness of breath,
progressive coughing, fever, difficulty in swallowing and
confusion. He was readmitted. His chest X-ray revealed
bilateral lung bases with increased interstitial prominence.
Laboratory examination revealed WBC count of 21.2 x 10
suggestive of an infection. Procalcitonin level was 0.12 ng/mL.
A diagnosis of hospital acquired pneumonia was made. He
again received antibacterials. Sputum culture showed
unidentified polymicrobial growth. A video swallow evaluation
revealed tracheoesophageal fistula in the middle third of the
oesophagus. He successfully underwent a palliative
oesophageal stent placement and upper endoscopy. He
tolerated diet without any complications and was sent for
further hospice care.
Author comment: "We here report a case of a 72-year-old
male who developed a [tracheoesophageal fistula] upon re-
irradiation of squamous cell cancer 1 year after treatment
with gemcitabine/carboplatin." "This case highlights the role of
radiotherapy and chemotherapy on development of
[tracheoesophageal fistula] on the setting of lung cancer."
Abugroun A, et al. Late onset chemo/radiation induced tracheoesophageal fistula in
squamous cell cancer of the lung. World Journal of Oncology 8: 171-173, No. 5,
Oct 2017. Available from: URL: http://doi.org/10.14740/wjon1063w -
Reactions 2 Dec 2017 No. 16800114-9954/17/1680-0001/$14.95 Adis © 2017 Springer International Publishing AG. All rights reserved