Metastatic Lung Adenocarcinoma Presenting After Kidney Transplant

What happened, in summary

A 52-year-old man presented with right-leg swelling 4 months after a kidney transplant. He had previously smoked for 40 pack-years, although pre-transplant screening had not identified cancer. During admission, he developed severe red-cell destruction, low platelets, and a continuing need for blood transfusions. Several transplant-related, infectious, autoimmune, and complement-related causes were considered and treated, but his condition continued to worsen.

He then developed fever, breathlessness, and back pain. Chest imaging showed a spiculated mass in the right lower lung with mediastinal nodes and pleural and pericardial fluid. MRI found diffuse disease in the spine and bony pelvis. A bone-marrow biopsy showed extensive necrosis and metastatic adenocarcinoma. The malignant cells were TTF-1 positive, supporting a lung primary.

His functional condition declined rapidly from independent living to needing help with most activities within 3 weeks. He was not well enough to receive chemotherapy and was transitioned to palliative care. He died 1 week after the diagnosis. The blood disorder was considered most likely a paraneoplastic complication of the disseminated lung cancer.