Is High White Blood Cell Count an Adverse Drug Reaction of PD-1 Or Paraneoplastic Syndrome? A Case of Adenocarcinoma of the Lung

A Case of Adenocarcinoma of the Lung

Abstract

Paraneoplastic syndromes are tumour-associated indirectly related clinical disorders. Here, we present a 58-year-old woman with impaired glucose tolerance and a gradual increase in white blood cell count. In May 2019, the patient was diagnosed with adenocarcinoma of the lung and engaged in a series of chemotherapy followed by PD-1 therapy at last. About a month following her last PD-1 cycle, she indicated some clinical disorders. Haematological studies on and after admission revealed a white blood cell count that progressively increased up to 84.69×109/L. CT scan of the abdomen unveiled the presence of a cyst and a tumour connected. Repeated blood cultures, as well as bacterial genetic testing of the cyst drainage were all negative. Bone marrow biopsy exhibited a normal pathological appearance, and bone marrow liquid examination by flow cytometry was regular. Diagnosis of an adverse drug reaction of PD-1 therapy or a paraneoplastic syndrome was accepted. Following the patient's tumour progress, the patient was treated with a combination of Albumin paclitaxel and Endostar chemotherapy. After the treatment, a progressive restoration of the patient's condition, blood cell counts, and vital signs were observed. Three days after the treatment, the patient's platelet count significantly dropped, and she was given rhIL-11, which restored this number by day 8. The white blood cell count dropped on day 3 post-chemotherapy as well, but without any treatment, re-increased to 10.89×109/L on day 6 and more by day 7: 39.8×109/L, and up to 44.3×109/L by day 8.