Abstract
A 77-year-old man with an abnormal shadow on a chest radiograph was admitted to our hospital for a more detailed examination in September 2003. After a diagnosis of adenocarcinoma with a suspicion of mediastinal node involvement (cT2aN2M0, stage III A) was made following a chest CT scan and transbronchial biopsy, new faint infiltrates appeared in the left upper lobe on a repeated chest CT scan. Because the tumor narrowed the left upper bronchus and these infiltrates were limited in the upper lobe, we diagnosed the new lesions as obstructive pneumonia caused by the tumor, and an operation was performed. As the entire left upper lobe and left segment 6 were hard like the liver, total pneumonectomy was required. The pathological diagnosis was lung adenocarcinoma and organizing pneumonia (OP). Although he improved and was discharged on the 12th postoperative day, dyspnea appeared with infiltrative shadows in the right lung which resembled the faint infiltrates in the left upper lobe. He was admitted again on the 18th postoperative day. Two pulse therapies of corticosteroid followed by macrolide treatment were given, and he was discharged on the 76th day after the second admission. In cases of lung cancer complicated with infiltrates that appear sub-acutely and are resistant to antibiotics, it is important to consider the possibility of lung cancer complicated by interstitial pneumonia. Careful decisions are necessary in order to treat such cases.
