What happened, in summary

This 75-year-old man developed bilateral leg swelling and shortness of breath with exertion in October 2022 but did not seek formal medical care at first. By January 2023, he had much worse exercise tolerance, difficulty breathing while lying flat, fatigue, low urine output, poor appetite, poor sleep, constipation, and reduced urine volume. After 2 weeks of herbal therapy without improvement, he was referred to a larger hospital. Blood tests showed marked leukocytosis and severe eosinophilia. NT-proBNP was very high, suggesting severe cardiac strain. Echocardiography showed endocardial thickening, intracardiac thrombus, and left atrial and ventricular enlargement, consistent with Löffler endocarditis. Chest CT showed a mass-like high-density shadow in the left upper lobe with bronchial cutoff. Lung biopsy found atypical nested cells consistent with non-small cell lung cancer, and immunohistochemistry supported lung adenocarcinoma: AE1/AE3, Vimentin, P63, P40, Napsin-A, and TTF-1 were positive, while Synaptophysin and CD56 were negative; Ki-67 was about 30%. His family declined corticosteroid therapy. Treatment focused on cardiopulmonary support, including recombinant human brain natriuretic peptide, diuretics, aminophylline, and rivaroxaban, but his condition did not improve. After cancer confirmation, the family stopped further treatment and requested discharge. In March 2023, he was readmitted with worsening dyspnea, leg swelling, increased bilateral pleural effusions, bilateral pneumonia, and Acinetobacter baumannii infection. Despite antibiotics, vasopressors, nutritional support, suctioning, intubation, and mechanical ventilation, oxygen saturation remained unstable and hypotension progressed. The family withdrew care and requested voluntary discharge. The case links 2 serious processes: lung adenocarcinoma and hypereosinophilic cardiac disease. The family declined steroid therapy and later cancer-directed care, so management remained supportive during a course marked by worsening respiratory failure and infection.