Complex Case Of Copd Exacerbation With Lung Cancer And Paraneoplastic Syndrome: A Case Report

Syazili Mustofa, Faizah Zahrah Sidik, Evi Kurniawaty, Miftahur Rohman, Nisa Karima

Sari


Managing Chronic Obstructive Pulmonary Disease (COPD) alongside advanced lung cancer is highly complex, especially when complicated by multiple paraneoplastic syndromes. We present a 70-year-old male with shortness of breath, hemoptysis, and significant weight loss. Evaluation revealed an acute COPD exacerbation unmasking a metastatic right lung cancer with a rare combination of concurrent paraneoplastic syndromes (anemia, hyponatremia, and hypocalcemia). The uniqueness of this case lies in how these overlapping systemic manifestations masked the acute respiratory exacerbation, creating a profound diagnostic dilemma. Clinically, this implies that physicians must maintain a high index of suspicion for underlying malignancies when treating atypical or refractory COPD exacerbations. The key lesson learned is that managing such intertwined conditions requires prompt, individualized, and multidisciplinary coordination to prevent delayed interventions and optimize patient outcomes.


Kata Kunci


COPD; Hemoptysis; Lung Cancer; Malnutrition; Paraneoplastic Syndrome

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Achrol, A. S., Rennert, R. C., Anders, C., Soffietti, R., Ahluwalia, M. S., Nayak, L., Peters, S., Arvold, N. D., Harsh, G. R., Steeg, P. S., & Chang, S. D. (2019). Brain metastases. Nature Reviews Disease Primers, 5(1), 5. https://doi.org/10.1038/s41572-018-0055-y

Anwar, A., Jafri, F., Ashraf, S., Jafri, M. A. S., & Fanucchi, M. (2019). Paraneoplastic syndromes in lung cancer and their management. Annals of Translational Medicine, 7(15), 359. https://doi.org/10.21037/atm.2019.04.86

Arumsari, D., Artanti, K. D., Martini, S., & Widati, S. (2019). The Description Of Smoking Degree Based On Brinkman Index In Patients With Lung Cancer. Jurnal Berkala Epidemiologi, 7(3), 249–256. https://doi.org/10.20473/jbe.V7I32019.250-257

Briones-Claudett, K. H., Briones-Claudett, M. H., Moreno, A. P., Vargas, D. E., Alvarez, M. E. M., & Andrade, M. G. (2020). Spontaneous pneumothorax after rupture of the cavity as the initial presentation of tuberculosis in the emergency department. The American Journal of Case Reports, 21.

Cortes-Telles, A., Ortiz-Farias, D. L., Perez-Hernandez, F., &

Rodriguez-Morejon, D. (2021). Secondary spontaneous pneumothorax: A time to re-evaluate management. Respirology Case Reports, 9(8).

Dalimunthe, M. B., Pradana, A., Tarigan, A. P., & Amelia, R. (2024). The relationship between malnutrition and quality of life in stable chronic obstructive pulmonary disease patients at Prof. Dr. Chairuddin P. Lubis Hospital field. Journal of Society Medicine, 3(9), 280-287. https://doi.org/10.47353/jsocmed.v3i9.164

DeMaio, A., & Semaan, R. (2021). Management of pneumothorax. Clinics in Chest Medicine, 42(4), 729-738.

Franco, D. L., & Thomas, L. (2017). [Small cell lung cancer associated with multiple paraneoplastic syndromes]. Biomedica, 37(1), 8-10. https://doi.org/10.7705/biomedica.v37i1.2906

Ghisalberti, M., Guerrera, F., De Vico, A., et al. (2020). Age and clinical presentation for primary spontaneous pneumothorax. Heart, Lung and Circulation, 29(11), 1648-1655.

Gottlieb, M., & Long, B. (2023). Managing spontaneous pneumothorax. Annals of Emergency Medicine, 81(5), 568-576.

Huan, N. C., Sidhu, C., & Thomas, R. (2021). Pneumothorax: Classification and etiology. Clinics in Chest Medicine, 42(4), 711-727.

Ki, M. S., Jeong, D., Kang, H. Y., Choi, H., Sohn, H., & Kang, Y. A. (2023). Real-world impact of the fixed-dose combination on improving treatment outcomes of drug-susceptible tuberculosis: A comparative study using multiyear national tuberculosis patient data. BMJ Open Respiratory Research, 10(1).

Le Rhun, E., Guckenberger, M., Smits, M., Dummer, R., Bachelot, T., Sahm, F., Galldiks, N., de Azambuja, E., Berghoff, A. S., Metellus, P., Peters, S., Hong, Y.-K., Winkler, F., Schadendorf, D., van den Bent, M., Seoane, J., Stahel, R., Minniti, G., Wesseling, P., ... Preusser, M. (2021). EANO–ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up of patients with brain metastasis from solid tumours. Annals of Oncology, 32(11), 1332–1347. https://doi.org/10.1016/j.annonc.2021.07.016

Mendogni, P., Vannucci, J., Ghisalberti, M., et al. (2020). Epidemiology and management of primary spontaneous pneumothorax: A systematic review. Interactive Cardiovascular and Thoracic Surgery, 30(3), 337-345.

Muliaditan, M., & Della Pasqua, O. (2021). Evaluation of pharmacokinetic-pharmacodynamic relationships and selection of drug combinations for tuberculosis. British Journal of Clinical Pharmacology, 87(1), 140-151.

Muscaritoli, M., Arends, J., Bachmann, P., et al. (2021). ESPEN practical guideline: Clinical nutrition in cancer. Clinical Nutrition, 40(5), 2898-2913.

Paskaradevan, J., Sayad, E., & Sockrider, M. (2020). What is a spontaneous pneumothorax?. American Journal of Respiratory and Critical Care Medicine, 202(12).

Pérez-Bucio C, Behere A and Landegren N (2025) Mechanisms of autoimmune-mediated paraneoplastic syndromes: immune tolerance and disease pathogenesis. Front. Immunol. 16:1608934. doi: 10.3389/fimmu.2025.1608934

Pradana, A. D. (2020). Spontaneous tuberculosis-associated tension pneumothorax: A case report and literature review. Case Reports in Acute Medicine, 3(2), 35-39.

Ren, Y., Ren, M., Yang, F., Cui, F., Chen, Z., Ling, L., Wang, F., & Huang, X. (2016). Multiple paraneoplastic syndromes associated with small cell lung cancer: A unique case of concomitant Lambert-Eaton myasthenic syndrome, paraneoplastic cerebellar degeneration and syndrome of inappropriate secretion of antidiuretic hormone. International Journal of Clinical and Experimental Medicine, 9(2), 4939-4942.

Shapiro, A. E., Ross, J. M., Yao, M., et al. (2021). Xpert MTB/RIF and Xpert Ultra assays for screening for pulmonary tuberculosis and rifampicin resistance in adults irrespective of signs or symptoms. Cochrane Database of Systematic Reviews, (3).

Shojaan, H., Kalami, N., Alamdari, M. G., et al. (2023). Diagnostic value of the neutrophil lymphocyte ratio in discrimination between tuberculosis and bacterial community-acquired pneumonia: A meta-analysis. Journal of Clinical Tuberculosis and Other Mycobacterial Diseases, 100395.

Stefani, A., Aramini, B., Baraldi, C., et al. (2020). Secondary spontaneous pneumothorax and bullous lung disease in cannabis and tobacco smokers: A case-control study. PLoS One, 15(3).

Tran, J., Haussner, W., & Shah, K. (2021). Traumatic pneumothorax: A review of current diagnostic practices and evolving management. The Journal of Emergency Medicine, 61(5), 517-528.

Živković, Z., Ostojić, O., Veković, V., et al. (2023). Pulmonary tuberculosis and spontaneous pneumothorax in an adolescent – Case report. Preventive Paediatrics, 89-92.




DOI: https://doi.org/10.33024/jikk.v13i4.22914

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