Key result
Adjuvant immunotherapy for TNBC precedes rapid, fatal pulmonary tumor thrombotic microangiopathy diagnosed postmortem.
Case Report (n=1)
Pulmonary tumour thrombotic microangiopathy should be considered in cancer patients presenting with severe hypoxia, thrombocytopaenia, and right heart failure, as it can mimic immunotherapy-associated pneumonitis and carries an extremely poor prognosis.
We present a case of pulmonary tumour thrombotic microangiopathy (PTTM) in a patient on adjuvant immunotherapy for resected triple negative breast cancer. The patient presented with deranged liver function tests and subsequently developed severe hypoxia and thrombocytopaenia, with right heart failure. The primary differential diagnosis considered was immunotherapy-associated hepatitis and pneumonitis. Despite organ support, the patient deteriorated rapidly and died of respiratory failure. As is often the case with PTTM, the diagnosis was only found at postmortem. PTTM should be considered in patients with a background of cancer (and may be more common in certain subtypes) who present with this unusual combination of clinical features. While the condition carries an extremely poor prognosis, prompter recognition for future patients may allow consideration of novel treatments.
No takes yet. Share an insight, caveat, or question.
McKenzie et al. (2023) conducted a case report in Pulmonary tumour thrombotic microangiopathy (PTTM) (n=1). Adjuvant immunotherapy was evaluated on Clinical course and postmortem diagnosis. A patient on adjuvant immunotherapy for triple negative breast cancer rapidly deteriorated and died from pulmonary tumour thrombotic microangiopathy, which was diagnosed postmortem.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: