Neurofibromatosis type 1: a case highlighting pulmonary and other rare clinical manifestations

BMJ Case Rep. 2018 Jan 31:2018:bcr2017222614. doi: 10.1136/bcr-2017-222614.

Abstract

Neurofibromatosis type 1 (NF1)-related lung disease is a rare but increasingly recognised, high morbidity associated feature of the condition. We present a 48-year-old male patient with NF1, who was initially admitted for a subarachnoid haemorrhage requiring aneurysmal coil embolisation. During his recovery, he developed a left-sided pneumothorax requiring chest tube placement followed by concerns for re-expansion pulmonary oedema requiring intubation. Subsequently, the patient also developed a right-sided pneumothorax requiring additional chest tube placement but did not develop right-sided pulmonary oedema. During his hospitalisation, the patient also exemplified other important NF1-related pathophysiology including pheochromocytoma, cerebrovascular abnormalities and cardiovascular manifestations. Due to his multiple comorbidities and poor prognosis, we held a goals of care discussion with the patient's mother, and with her agreement, the patient underwent compassionate withdrawal of artificial life support.

Keywords: adrenal disorders; cardiovascular medicine; genetic screening / counselling; neurology; respiratory medicine.

Publication types

  • Case Reports

MeSH terms

  • Adrenal Gland Neoplasms
  • Chest Tubes
  • Comorbidity
  • Decision Making
  • Disease Progression
  • Embolization, Therapeutic
  • Humans
  • Intubation
  • Life Support Care*
  • Lung / diagnostic imaging*
  • Male
  • Middle Aged
  • Neurofibromatosis 1 / complications
  • Neurofibromatosis 1 / physiopathology*
  • Neurofibromatosis 1 / therapy
  • Pheochromocytoma
  • Pneumothorax / diagnostic imaging*
  • Pneumothorax / physiopathology
  • Pneumothorax / therapy
  • Prognosis
  • Pulmonary Edema / diagnostic imaging*
  • Pulmonary Edema / physiopathology
  • Pulmonary Edema / therapy
  • Stroke / diagnostic imaging
  • Stroke / etiology
  • Stroke / physiopathology*
  • Stroke / therapy
  • Subarachnoid Hemorrhage / diagnostic imaging
  • Subarachnoid Hemorrhage / physiopathology*
  • Subarachnoid Hemorrhage / therapy
  • Terminal Care
  • Withholding Treatment*