Abstract
An 80-year-old man underwent lobectomy of the left upper lobe for lung cancer with combined pulmonary fibrosis and emphysema (CPFE). Histological examination of noncancerous lung tissue revealed a usual interstitial pneumonia pattern. The arterial oxygen tension/fraction inspired oxygen (P/F) ratio decreased to 67 on postoperative day (POD) 11 and a ground-glass opacity appeared mainly in the right lung field on chest computed tomography, suggesting respiratory failure due to acute exacerbation of interstitial pneumonia. Despite systemic pulsed steroid therapy, the patient's respiratory status worsened and combination therapy consisting of direct hemoperfusion with polymyxin B immobilized fiber (PMX-DHP) and recombinant thrombomodulin was started on POD 13. Although artificial respiration was temporarily necessary, the P/F ratio improved to 135 after 48 hours of PMX-DHP treatment. At the time of the second course of systemic pulsed steroid therapy, the P/F ratio increased to 238 on POD 20. No relapses were subsequently observed. This case demonstrates successful multimodal treatment for an acute exacerbation of interstitial pneumonia after lobectomy for lung cancer with concomitant CPFE.
