CASE PRESENTATION
A male patient in his twilight years presented with a cough and white
sputum, symptoms which were more noticeable during the night. He also
developed edema in his lower limbs, although there were no signs of
fever, chest pain, or significant weight loss. The patient’s past
medical record was unremarkable, and he was generally in good health.
Enhanced CT scans of the chest and abdomen revealed multiple pulmonary
cavitary lesions, mediastinal and supraclavicular lymph nodes
enlargement, and a liver mass (figure 1). The laboratory tests showed a
spike in the white blood cell and neutrophil count (table 1), while
sputum culture showed no presence of pathogens (table 2). However, a
surge in tumor markers such as neuron-specific enolase, calcitonin, and
non-small cell carcinoma antigen index was observed (table 1). Electron
bronchoscopy and ultrasound-guided supraclavicular lymph node biopsy
confirmed the presence of metastatic adenocarcinoma (figure 4). An MR
scan displayed heterogeneous signals in the gallbladder, and the PET-CT
scan suggested increased FDG metabolism in the gallbladder, indicating a
potential primary lesion originating from the gallbladder. After a
multidisciplinary case discussion in our hospital, and considering the
metastatic characteristics of gallbladder carcinoma, the final diagnosis
was gallbladder carcinoma with multiple metastases to the lungs, lymph
nodes, and liver, along with a concurrent pulmonary infection. The
patient received treatment with levofloxacin for infection, promethazine
hydrochloride for suppressing the cough, and spironolactone, furosemide,
and other diuretics to alleviate his symptoms.