Necrotizing pneumonia/ pneumothorax

[ebaley]

Last December my dad was diagnosed with stage 3 non small squamous cell carcinoma with a large tumor in his upper left lobe. After radiation and chemo , everything looked great. The tumor shrunk by 90%. He was started in immunotherapy and after only receiving 2 doses it was stopped as ct showed Mets to the bones and positive pet lymph node on the  opposite lung. He received radiation to several spots including back tumor on L3 and small spot on femur. The plan next was to get 2 rounds of chemo and then we were going to seek out a suitable trial and had an intro consult at a major university near us. We all agreed he would complete radiation and chemo first before the trial meds. I believe he would be put on one of the new “ Trojan horse “ meds. Unfortunately after only 1 dose (half a round) of chemo , his course was complicated by hospitalization for several infections and neutropenia. All chemo is on hold now as he has developed necrotizing pneumonia with a pneumothorax to his left lung. At first the docs talked like it’s a bump in the road and a month of antiobiotics should clear it up. Then yesterday before he was discharged they came in and basically said the odds aren’t good for the infection to heal or the hole in his lung because the lung is so beat up from treatments and the large tumor already. Even though the cancer is basically gone from the lung , the damage is done. They sent him home with iv antiobiotics and a chest tube with follow up to both the lung docs and oncologist. We weee basically told to pray the lung can heal and infection go away , but some docs mentioned even if it does they are unsure if his lung/immune system  can even handle more chemo. Yesterday I reached out to the major university oncologist and explained and asked if there are any options that maybe have less a toll on the immune system like chemo. I am still waiting for a response back. We have been told  Worst case scenario - lung doesn’t heal and then cancer will likely take over if he can’t get more treatment and  in time he’ll pass. I am just devastated. Everything looked like it was going so well and now he gets hit with some super pneumonia. Even a scan for the pneumonia happened to show he already had a major decrease in size of lymph nodes from just 1 chemo. Does anyone have any experience with this type of situation or necrotizing pneumonia with pneumothorax? Any info is very much appreciated. I just don’t want to sit idle and watch him go untreated and have this God awful disease just take over.  Thanks 

[Tom Galli]

Ebaley,

Welcome here and very sorry to learn of your dad's difficulties.

While I've not had necrotizing pneumonia (a bacterial pneumonia), I've had several episodes of viral pneumonia one of which landed me in the hospital for a long stays in intensive care after my right lung was removed. Pneumothorax is a collapsed lung and I've had one of those. Do I understand your dad was discharged from hospital with these active conditions? Who is managing the IV antibiotics and attending to the chest tube dressing and drain? I find treatment of these complex disorders outside of a hospital setting hard to contemplate.

Pneumonia is fluid inside the lung and that in combination with a collapsed lung is a very serious, life threatening condition.  Getting hospital care for these problems would be my first recommendation. 

Stay the course.

Tom