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DOI: 10.1055/s-0037-1600729
Cerebrospinal Fluid Rhinorrhea after Systemic Erlotinib Chemotherapy for Metastatic Lung Cancer: A Familiar Problem from an Unfamiliar Culprit
Publication History
Publication Date:
02 March 2017 (online)
Introduction: Cerebrospinal fluid (CSF) leak after medical therapy for pituitary prolactinoma is a rare but well-described phenomenon. However, to our knowledge, no CSF leaks have been reported after the non-surgical treatment of pituitary or anterior skull base metastases.
Results: A 66-year-old woman presented with EGFR-mutant Stage IV adenocarcinoma of the lung. Headache workup revealed a large pituitary lesion consistent with metastatic disease. Systemic erlotinib chemotherapy was initiated with a robust positive response. However, ~1 week after chemotherapy initiation, she noted clear discharge from the nares. Her oncologist first diagnosed her with allergic rhinitis, but she eventually presented with meningitis and was admitted for IV antibiotics and definitive repair of a CSF leak via an endoscopic endonasal approach. An erosion of bone and dura was found at the dorsum sella where tumor had regressed due to the chemotherapy. A multilayer skull base repair was made uneventfully and she recovered fully with no leakage on follow-up.
Conclusion: We report this unusual case to raise awareness of spontaneous CSF leaks in the setting of skull base metastatic disease. All members of the treatment team should be aware of this possibility after initiation of systemic chemotherapy and tumor regression, and urgently refer patients for repair prior to suffering meningitis if a leak should develop.