Malignant Mesothelioma Manifesting in an Elderly Female without Occupational Asbestos Exposure

Abstract

Case Presentation: A 71-year-old Caucasian female with a history of SARS-CoV-2 pneumonia, chronic obstructive pulmonary disease (COPD) and 50 pack-years smoking presented with dyspnea, cough, fever, anorexia, and 12-pound weight loss over two weeks. She had three recent hospitalizations for COPD exacerbation and pneumonia. She was noted to be hypoxic despite five liters/minute of supplemental oxygen. Laboratory studies revealed leukocytosis, hypernatremia, and elevated brain natriuretic peptide. Urine streptococcal and legionella antigens, and respiratory viral panel were negative. Chest radiograph [Figure 1] revealed lobulated left-sided pleural masses, which were confirmed on computed tomography (CT) scan of the chest [Figure 2]. CT-guided pleural biopsy was performed, and the diagnosis of malignant mesothelioma (MM) was established. Positron emission tomography revealed avidity of the pleural masses [Figure 3]. The patient denied occupational asbestos exposure, however she reported routinely laundering her husband's clothing who worked extensively with asbestos. She elected to pursue hospice care.