Case Report
Copyright ©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Oct 6, 2019; 7(19): 3039-3046
Published online Oct 6, 2019. doi: 10.12998/wjcc.v7.i19.3039
Bronchobiliary fistula after ramucirumab treatment for advanced gastric cancer: A case report
Hong-Beum Kim, Yong Sub Na, Hee-Jeong Lee, Sang-Gon Park
Hong-Beum Kim, Department of Premedical Course, Chosun University School of Medicine, Dong-gu, Gwangju 501-717, South Korea
Yong Sub Na, Department of Internal Medicine, Pulomonology, Chosun University Hospital, Dong-gu, Gwangju 501-717, South Korea
Hee-Jeong Lee, Sang-Gon Park, Department of Internal Medicine, Hemato-oncology, Chosun University Hospital, Dong-gu, Gwangju 501-717, South Korea
Author contributions: Kim HB were the major contributors in writing the manuscript; Na YS and Lee HJ advised the manuscript; Park SG were involved in drafting, writing and editing the manuscript, and reviewed the manuscript as corresponding author; all authors read and approved the final manuscript.
Informed consent statement: Written informed consent was obtained from the patient for publication of this case report and any accompanying images.
Conflict-of-interest statement: The authors declare no conflict-of-interest.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Sang-Gon Park, MD, PhD, Assistant Professor, Department of Internal Medicine, Hemato-oncology, Chosun University Hospital, 365 Pilmun-daero, Dong-gu, Gwangju 501-717, South Korea. sgpark@chosun.ac.kr
Supported by the National Research Foundation of Korea, funded by the Ministry of Science, ICT, and Future Planning, No. NRF-2015R1A5A2009070.
Telephone: +82-62-2203984 Fax: +82-62-2349653
Received: July 11, 2019
Peer-review started: July 17, 2019
First decision: August 2, 2019
Revised: August 7, 2019
Accepted: September 13, 2019
Article in press: September 13, 2019
Published online: October 6, 2019
Abstract
BACKGROUND

Bronchobiliary fistula (BBF) is a rare disease characterized by an abnormal connection between the biliary system and bronchi. Traditional causes of BBF include trauma and infections, and more recent causes include malignancies and certain cancer treatments. Ramucirumab is an antivascular endothelial growth factor receptor 2 monoclonal antibody, currently used as a second-line treatment for gastric cancer.

CASE SUMMARY

A 43-year-old man visited our hospital with the complaint of jaundice. He was diagnosed with inoperable advanced gastric cancer owing to invasion of the hepatic hilum by the tumor. After percutaneous transhepatic biliary drainage (PTBD) and stent placement, capecitabine and oxaliplatin were administered as first-line palliative chemotherapy. The tumor progressed, and paclitaxel and ramucirumab were administered as second-line chemotherapy. However, on the first day of the second cycle, the patient suddenly developed dyspnea and pneumonia. BBF was diagnosed on the basis of the presence of bilious sputum and the results of computed tomography, and PTBD was repeated.

CONCLUSION

This is the first report of BBF after administration of the new antiangiogenic agent ramucirumab.

Keywords: Ramucirumab, Liver, Bronchobiliary fistula, Advanced gastric cancer, Case report

Core tip: This report is significant and will be of interest to readers because it describes an extremely rare case of bronchobiliary fistula (BBF) developing after chemotherapy for advanced gastric cancer. Moreover, it is the first report on BBF occurring after the administration of the new antiangiogenic agent ramucirumab.