Fever in a Patient with a Rare Adult‐Onset Neuroblastoma

1North Shore University Hospital, Manhasset, NY
2North Shore University Hospital, Manhasset, NY
3North Shore University Hospital, Manhasset, NY

Meeting: Hospital Medicine 2013, May 16-19, National Harbor, Md.

Abstract number: 249

Case Presentation:

A 30‐year‐old woman with a medical history of ovarian cancer in remission developed a stage 3 neuroblastoma. CT scan of the head showed a heterogeneously enhancing mass involving bilateral sphenoid sinuses that extended into the left pterygopalatine fossa, cavernous sinus, and posterior aspect of the nasopharynx. A left sphenoid sinus biopsy revealed the presence of high‐grade neuroendocrine tumor consistent with a neuroblastoma. She was treated with chemotherapy and radiation therapy. We became involved in her care when she presented with fevers up to 103°F degrees, URI symptoms, headaches, facial pain, and odynophagia. CT scan of the head was unchanged since May 2012. Chest x‐ray showed improving bilateral airspace opacities were believed to be a result of prior infection. Blood, sputum, and urine cultures were negative; as was a respiratory viral panel. No other source of infection was identified. Very broad‐spectrum empiric therapy was initiated, but gradually discontinued as culture results came back negative. An MRI of the brain with contrast on hospital day 2 showed residual disease involving the left pterygopalatine fossa, the left sphenoid sinus, and left posterior ethmoid regions. Ultimately her symptoms and fever were all ascribed to the neuroblastoma.

Discussion:

Neuroblastoma is the most common extracranial solid tumor in childhood. The average time of diagnosis is around 2 years of age, 35% occurring before 1 year. Neuroblastoma is very rare among adolescents and young adults. In fact, only about 10% of neuroblastoma cases occur after age 5. Neuroblastomas arise in the abdomen in 60% of cases, followed by 15% in the thorax; 5% in the pelvis; and 5% in the cervical sympathetic chain. At this time, there is no standard treatment for adult neuroblastoma. Pediatric treatment protocols have not been shown to be as beneficial in adults, and localized neuroblastoma involves a far more aggressive course in adults than in children. Metastasis and local tumor invasion contribute to the symptoms of neuroblastoma. Importantly, tumor‐related inflammation is an important source of symptoms, morbidity, and mortality. As neuroblastoma is associated with increased activity of proinflammatory cytokines, fever is a common symptom, even if no infection is presen. Elevated levels of inflammatory cytokines can cause systemic symptoms such as fever, nausea, and vomiting that were observed in the case report.

Conclusions:

Neuroblastomas in adults are rare aggressive tumors marked by symptoms of systemic inflammation that can be difficult to treat. In general, when fever or hypotension is present in a cancer patient, a serious infection should be assumed, and high doses of empiric, broad‐spectrum antibiotics must be given. It is important for hospitalist to be aware that fevers in patients with malignancies such as neuroblastoma may be due to an inflammatory response. When culture results and other fever workup is negative, antibiotics can be discontinued.

To cite this abstract:

Farzan‐Kashani F, Avanzato C, Rosenberg D. Fever in a Patient with a Rare Adult‐Onset Neuroblastoma. Abstract published at Hospital Medicine 2013, May 16-19, National Harbor, Md. Abstract 249. Journal of Hospital Medicine. 2013; 8 (suppl 2). https://www.shmabstracts.com/abstract/fever-in-a-patient-with-a-rare-adultonset-neuroblastoma/. Accessed September 18, 2019.

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