title: Long-term survival following metachronous intratumoral hemorrhage in an HIV-infected patient with lung cancer.
abstract: Human immunodeficiency virus (HIV)-infected patients are likely to develop intracranial events. Due to the spread of highly active antiretroviral therapy (HAART), HIV-infected patients now survive longer, and metastatic non-AIDS-defining carcinoma is increasing. A 49-year-old man with HIV infection undergoing treatment with HAART developed an intratumoral hemorrhage in the right frontal lobe. He was diagnosed as having lung adenocarcinoma and was found to have a brain metastasis with bleeding. After treatment for intratumoral bleeding, a contralateral frontal lobe hemorrhage occurred within a month. The patient underwent a second craniotomy and removal of hematoma, followed by whole-brain radiotherapy. He was then treated with four cycles of cisplatin and gemcitabine combination chemotherapy while receiving HAART. A partial response was achieved, though he developed severe hematological toxicities for which the doses of chemotherapy needed to be decreased. However, as a result of treatment, his activities of daily life recovered gradually. This lung cancer patient had been alive for 17 months despite the coexistence of two disorders with a poor prognosis, HIV infection and bleeding brain metastases from lung cancer. This case revealed that physicians must include non-AIDS-defining cancer metastasis to the brain in the differential diagnosis of HIV-infected patients when they show stroke-like symptoms, and such patients may respond to treatment as well as non-HIV-infected patients with advanced lung cancer.
authors.affiliation: Department of Respiratory Medicine, Tokyo Metropolitan Cancer and Infectious diseases Center, Komagome Hospital, 3-18-22 Honkomagome, Bunkyo, Tokyo, 113-8677, Japan.
authors.forename: Yusuke
authors.initials: Y
authors.lastname: Okuma
authors.forename: Yukio
authors.initials: Y
authors.lastname: Hosomi
authors.forename: Yusuke
authors.initials: Y
authors.lastname: Takagi
authors.forename: Shingo
authors.initials: S
authors.lastname: Miyamoto
authors.forename: Tsuneo
authors.initials: T
authors.lastname: Shimokawa
authors.forename: Mari
authors.initials: M
authors.lastname: Iguchi
authors.forename: Tatsuru
authors.initials: T
authors.lastname: Okamura
authors.forename: Kuniaki
authors.initials: K
authors.lastname: Saito
authors.forename: Masahiko
authors.initials: M
authors.lastname: Shibuya
mesh_terms: D000230:Adenocarcinoma / Q000150:complications / Q000556:secondary* / Q000628:therapy; D023241:Antiretroviral Therapy, Highly Active; D001932:Brain Neoplasms / Q000150:complications / Q000556:secondary* / Q000628:therapy; D017024:Chemotherapy, Adjuvant; D003128:Coma / Q000209:etiology; D016371:Cranial Irradiation; D003399:Craniotomy; D015658:HIV Infections / Q000150:complications* / Q000188:drug therapy; D006407:Hematoma, Epidural, Cranial / Q000209:etiology; D006801:Humans; D020300:Intracranial Hemorrhages / Q000209:etiology* / Q000601:surgery; D008175:Lung Neoplasms / Q000150:complications / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D018714:Radiotherapy, Adjuvant; D012008:Recurrence; D012086:Reoperation; D013997:Time Factors; D016896:Treatment Outcome
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