A Case of Pulmonary Tumor Thrombotic Microangiopathy Improved by the Treatment with Prednisolone

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Pulmonary tumor thrombotic microangiopath (PTTM) presents with severe manifestations and rapid progression and is difficult to diagnose ante mortem. We report a case of gastric adenocarcinoma diagnosed with PTTM before death. Chest XR and CT showed ground-glass shadows in the bilateral lung fields, gastric adenocarcinoma was demonstrated by gastrointestinal fiber scopy and biopsy, and poorly differentiated carcinoma cells were detected in the pulmonary arterial blood by pulmonary wedge aspiration cytology on cardiac catheterization. After diagnosis of PTTM, prednisolone therapy of 30 mg/day was started. Dyspnea and hypoxemia were improved on the next day of administration of prednisolone. Although PTTM is rare, it should be considered the differential diagnosis of pulmonary hypertension and progressive respiratory failure with diffuse ground-glass shadow on chest radiographies. Furthermore, administration of prednisolone should be considered one of the treatment for the dyspnea by PTTM.