Lung cancer initially presenting with diffuse alveolar damage and brain infarction: An autopsy case report

A 67-year-old man presented with dyspnea, right hemiparesis, and dysarthria. Chest computed tomography (CT) revealed extensive pulmonary infiltrates and a small nodule in the left upper lobe. Brain magnetic resonance imaging revealed multiple acute cerebral infarctions. Despite comprehensive management, the patient died from progressive respiratory failure. Autopsy revealed pleomorphic carcinoma of the lung (pT1bN1M1c, pStage IVB), diffuse alveolar damage (DAD), and nonbacterial thrombotic endocarditis. To the best of our knowledge, this is the first report of lung cancer initially diagnosed based on the simultaneous presentation of DAD and cerebral infarction. The rarity and concurrence of these manifestations suggests a potential paraneoplastic link.