Recurrent Lung Abscesses during Chemotherapy in Non-neutropenic Patient with Limited Stage Small Cell Lung Cancer: A Case Report and Review

Background: Small cell lung cancer (SCLC) represents 14% of all lung cancer cases. The current standard of care for limited stage SCLC is the chemotherapy combination of EP (etoposide, cisplatin) with concomitant radiotherapy. Treatment protocol is tolerated well and is associated with few side effects.Case Description: 58 y.o. lady diagnosed to have limited stage SCLC in our institute in November 2013. She was planned for concomitant chemoradiotherapy (CCRT). She started initially on chemotherapy protocol EP. On day 12 of cycle 2, the patient complained of Fever, excessive cough. CT thorax showed newly developed peripherally situated pulmonary abscess. She was kept in with IV antibiotics, and her condition was improved thereafter. Then she was started on CCRT, with cycle 3 EP. On day 6 of her cycle 3, she developed fatigue, poor general condition, high fever, cough and neutropenia. She was admitted as neutropenic sepsis, with improvement of neutropenia after only 1 shot of short acting GCSF. Sputum culture showed Klebsiella pneumonia. CT Thorax showed new lung abscess in the Left ligula. She was treated by IV antibiotic for 10 days. Her condition was improving thereafter and she was returned back to radiotherapy, as well as Cycle 4 EP. Currently, she finished her treatment since 1 month with no complication related to treatment protocol. Discussion: Although few, studies attributed the reason for lung abscess development to leuconeutropenia in some patients, and to relatively large primary tumour size in other patients. Conclusion: Many reasons may explain the development of lung abscess in non-neutropenic patient including chemotherapy side effect, underlying chest condition, and relatively large primary tumour size.