What happened, in summary

A 36-year-old man first presented in March 2024 with cough, coughing up blood, and chest pain. Imaging confirmed pulmonary embolism and also showed small lung nodules. After initial anticoagulation and treatment for suspected infection, his symptoms improved, but the pulmonary embolism and hemoptysis returned about two months later.

Because he also had enlarged head-and-neck lymph nodes, itching, eosinophilia, and elevated IgE, an inflammatory disorder was initially considered. Lymph-node biopsy instead found cancer cells. Further lung biopsy and whole-body imaging established poorly differentiated lung adenocarcinoma with bone metastases, classified as Stage IV.

He started alectinib as targeted anticancer therapy while also receiving anticoagulation for the pulmonary embolism. His symptoms improved during the hospitalization and he continued alectinib after discharge. At one-month follow-up, tumor-marker levels were steadily declining and the pulmonary embolism had not recurred.