A 53-year-old man with a metastatic solitary fibrous tumor (SFT) was admitted because of recent onset dyspnea. Two days before admission and one day after a third Tbt cycle, he presented abrupt shortness of breath with orthopnea and ankle swelling without chest pain, fever or chills. The same symptoms have already been present after the previous Tbt administrations with increased severity with each cycle, but resolved spontaneously after five to seven days.
He suffered from arterial hypertension, hypercholesterolemia, type 2 diabetes and hypothyroidism. He had been diagnosed with a cerebral SFT ten years earlier in the setting of seizures, revealing a right occipital mass which was surgically removed immediately followed by whole brain irradiation. Five years later, hepatic and pancreatic relapses were managed by surgical resection. One year later, liver and lung progression mandated weekly adriamycin (cumulative dose 375 mg/m2), with disease control for 9 months. He then received a combination of ramucirumab and an angiopoietin 2 inhibitor (phase I trial), discontinued after 4 months for grade III hypertension. After 4 months of therapeutic break he received pazopanib for metastatic progression. After a new multi-site metastatic progression, a fourth line of cyclophosphamide (200 mg daily) and a fifth line of paclitaxel (80 mg/m2 weekly) were administered, both without anti-tumoral effect. Three months before the current admission Tbt 1.5 mg/m2 every three weeks was initiated for disease progression.
Upon hospital admission, physical examination revealed tachypnea, bilateral jugular veins distention and inferior limb edema with crackles in the left lower lung area. Arterial blood gases, breathing room air, showed pH 7,47; PaCO2 33 mmHg; PaO2 68 mmHg and blood analysis a grade 2 anemia, grade 1 acute renal failure and NT-pro-BNP at 2800 pg/mL (N < 143 pg/mL). D-dimers and troponin were within normal range while EKG showed only a left atrial hypertrophy. An angiographic chest CT revealed already known bilateral pulmonary metastases and no arguments for any infectious process, pleural or pericardial effusion. NT-pro-BNP measurements gradually increased since receiving Tbt (from 356 pg/mL after the first cycle to 2800 pg/mL four days after the third cycle). A drug-related cardiac failure was suspected and intravenous furosemide. Intravenous furosemide (40 mg) resulted in rapid clinical improvement. Four days later an echocardiography was unremarkable. Subsequent coronary computed tomographic angiography and an isotopic evaluation of left ventricular ejection fraction were normal. He was discharged with oral furosemide with symptoms relief. Tbt was permanently discontinued.