Bilateral Spontaneous Pneumothorax in a Patient With Metastatic Leiomyosarcoma Receiving Pazopanib: A Case Report

Pneumothorax can be a rare but significant adverse event in patients with sarcoma and pulmonary metastases. This case report presents an instance of bilateral pneumothorax in a patient with metastatic leiomyosarcoma treated with pazopanib. A 74-year-old man with a history of grade 3 leiomyosarcoma and lung metastases was admitted with severe respiratory distress. He had been receiving pazopanib therapy following previous treatment with high-dose ifosfamide, doxorubicin, and radiotherapy. Imaging revealed bilateral pneumothorax, and the patient subsequently experienced respiratory arrest requiring immediate resuscitation measures including needle decompression followed by chest tube placement. The patient had experienced a unilateral pneumothorax two months prior to this presentation, which had resolved with standard interventions. While the bilateral pneumothorax eventually resolved after nine days of chest tube drainage, the patient exhibited no neurological recovery following the arrest, with brain imaging revealing bilateral cortical laminar necrosis. His clinical condition deteriorated significantly after 28 days in the intensive care unit (ICU), culminating in septic shock and death. This case highlights a serious pulmonary complication that can occur during the treatment of metastatic leiomyosarcoma, particularly in patients with lung metastases. The relationship between the development of pneumothorax and pazopanib therapy, along with the challenges in management and poor clinical outcome, merits consideration when treating similar patients.