Physicians presented the case study of a patient with lung cancer who had cold agglutinin disease (CAD) as a paraneoplastic syndrome in Archivos de Bronconeumología. 

The case details a 62-year-old man who presented with a 3-week history of unproductive cough and dizziness. A chest X-ray revealed a right upper lobe lung mass, which prompted the patient’s physicians to admit him for further investigations. 

History-taking revealed that the patient had a 100 pack-year smoking history. A computed tomography (CT) scan identified bilateral lung nodules, mediastinal adenopathies, and a hepatic nodule. A transthoracic needle biopsy revealed the mass to be a lung adenocarcinoma. A cranioencephalic CT scan revealed multiple brain nodules associated with vasogenic edema. 


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He was discharged but presented again 3 weeks later with asthenia, hematuria, jaundice, and constipation. Blood investigations revealed severe macrocytic anemia (hemoglobin, 4.2 g/dL) and leukocytosis. He also had elevated lactate dehydrogenase (1069 UI/L), bilirubin (6 mg/dL), and C-reactive protein (362 mg/dL) levels. 

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Immunology studies revealed that he was positive for a Coombs test, a C3d monospecific test, and irregular antibody screening. Combined, the investigations carried out suggested that he had autoimmune hemolytic anemia secondary to CAD. 

His physicians started him on antibiotics, as well as intravenous immunoglobulin for 2 days. In addition, he received 4 units of heated red blood cell concentrates (while his blood temperature was maintained above 35 °C). Blood and urine cultures revealed that he had a methicillin-sensitive Staphylococcus aureus infection. 

Two weeks later, the patient was again admitted for asthenia, anorexia, and joint pain. His condition continued to deteriorate despite treatment, and he died within a month. 

“In this case, the appearance of CAD as a paraneoplastic syndrome triggered frequent complications, leading to a deterioration of the patient’s general condition and several hospitalizations, which made the approach and treatment of the neoplasia very challenging,” the authors wrote. 

Reference

Pereira Barros P, Dos Santos B, Brito U. Lung cancer with cold agglutinin syndrome as a paraneoplastic syndrome: a case reportArch Bronconeumol. 2022;S0300-2896(22)00591-9. doi:10.1016/j.arbres.2022.10.003