Life Threatening Lymphoedema in Head and Neck Cancer

Abstract

Case summary61 year old male patient presented with the complaints of severe breathlessness, difficulty in swallowing and progressively increasing swelling all over face and neck to a local hospital where he underwent emergency tracheostomy and percutaneous endoscopic gastrostomy (PEG) for feeding. Eight years earlier, he was diagnosed to have carcinoma left tongue and underwent left hemiglossectomy with supraomohyoid dissection followed by radiotherapy (60 Gy in 30 fractions). Thereafter, he remained asymptomatic for six years. Two years earlier, he had non-healing ulcer on right side of tongue (Figure 1), biopsy of which revealed undifferentiated squamous cell carcinoma on histopathology and diagnosed to have recurrence of tongue cancer on right side for which he underwent right hemiglossectomy with supraomohyoid dissection followed by radiotherapy (45 Gy in 25 fractions) which he tolerated well with dry desquamation of skin and mucositis which was managed symptomatically.General examination on present admission revealed temperature: 98°F, pulse rate: 102/minute, blood pressure: 120/72 mm Hg, respiratory rate: 18/minute and swelling all over face and neck with skin dehiscence watery discharge. Respiratory system examination revealed crepitation in right basal region on auscultation. Other systemic evaluation was unremarkable. Laboratory investigation revealed hemoglobin: 12.5 gm/ dl, total leukocyte count of 21,400/cm 3 with neutrophil predominance (72%). Other biochemical and serological parameter were within normal limits. He was managed with broad spectrum antibiotics and other supportive care. Despite best supportive care, patient's condition continued to worsen and succumbed to his illness.