Unmasking Carcinoid Syndrome in a Chronic Obstructive Pulmonary Disease (COPD) Patient: A Rare Presentation with Wheezing and Angioedema

TL;DR

A COPD patient presented with unexplained symptoms that were later found to be due to carcinoid syndrome, highlighting the importance of considering this rare condition in similar cases.

Contribution

This case report highlights the rare presentation of carcinoid syndrome in a COPD patient and emphasizes the importance of timely diagnosis.

Findings

The patient had elevated levels of serum serotonin, chromogranin A, and 5-HIAA, indicating carcinoid syndrome.

Imaging and biopsy confirmed a well-differentiated grade 1 neuroendocrine tumor with liver metastases.

Treatment with lanreotide led to symptom resolution, showing the effectiveness of targeted therapy.

Abstract

Carcinoid syndrome is a rare condition resulting from neuroendocrine tumors (NETs) that secrete vasoactive substances like serotonin. This report describes the case of a 61-year-old man with a history of chronic obstructive pulmonary disease (COPD) and hypertension who presented with new-onset angioedema, loss of consciousness, and a fall. He had been treated for COPD exacerbations during ER visits without improvement and was unaware of a prior mesenteric carcinoid tumor diagnosis from 2012. The next emergency evaluation revealed significant airway and facial edema necessitating intubation. Imaging and biopsy identified a well-differentiated grade 1 NET with extensive liver metastases. Laboratory tests showed elevated levels of serum serotonin, chromogranin A, and 24-hour urine 5-hydroxyindoleacetic acid (5-HIAA). Post-discharge, a PET scan confirmed metastatic lesions primarily in the liver and small bowel, with an unresectable mesenteric mass. The patient was treated with lanreotide and became symptom-free. This case underscores the need to consider carcinoid syndrome in patients with COPD presenting with unexplained respiratory symptoms, as timely diagnosis and treatment can significantly enhance patient outcomes.

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