Concurrent hemoptysis and pulmonary embolism associated with lenvatinib therapy for unresectable thymic carcinoma: A case report

Abstract

We describe a rare case of concurrent adverse events of hemoptysis and pulmonary embolism in a patient with unresectable thymic carcinoma treated with lenvatinib. A 73-year-old man undergoing treatment with lenvatinib 20 mg/day presented to our emergency department with complaining of hemoptysis. Contrast-enhanced chest computed tomography (CT) scan showed ground-glass opacities with right upper lobe predominance and suspected hemorrhage from the right upper lobe. In addition, the CT scan revealed pulmonary emboli scattered at the bilateral pulmonary arteries. Venous ultrasonography of the legs showed the presence of deep venous thrombosis from the left common femoral vein to the left superficial femoral vein. Bronchial arterial embolization was performed for hemoptysis and a percutaneous inferior vena cava filter was inserted to prevent further pulmonary embolism. There was no recurrence of hemoptysis and deterioration in respiratory status after these procedures. Lenvatinib, which was the presumed cause of these adverse events, was temporarily withdrawn but was resumed about a month after symptom improvement. Since the re-administration of lenvatinib, the patient has not experienced a recurrence of hemoptysis or thrombosis, and his thymic cancer is currently under control. This report illustrates the possibility of concurrent contrary adverse events due to lenvatinib. Clinicians should be careful not to allow prominent clinical signs to make them overlook comorbid adverse events. With an appropriate management of adverse effects, lenvatinib is a promising new drug for advanced-stage thymic carcinoma.

Keywords

• Lenvatinib
• Thymic carcinoma
• Hemoptysis
• Pulmonary embolism
• Bronchial arterial embolization