What happened, in summary

A 72-year-old man was diagnosed with Stage III small cell lung cancer after imaging found a large paratracheal lymph node and biopsy confirmed small cell carcinoma. He also had myasthenia gravis, which was treated separately. Cancer treatment began with concurrent cisplatin and etoposide plus chest radiation. During the first chemotherapy course, he developed febrile neutropenia. During the second, again given with dose reduction, he developed another episode of severe neutropenia and infection. Imaging showed that the treated lymph-node mass had cavitated and opened into the trachea, creating a tracheomediastinal fistula with mediastinitis. He required prolonged antibiotics, and further chemotherapy was stopped because of the infection risk. Despite the serious complication, the cancer had responded to treatment. Four months after therapy began, there was no evident recurrence of small cell lung cancer. The fistula persisted, and repair with a stent was being considered after infection control.