Case Reports and Reviews: Open Access

Background: Pleural effusion in advanced illness presents complex challenges in balancing symptom relief with the burden of invasive interventions. Case presentation: We report a 69-year-old bedbound male with a history of cerebrovascular accident, dementia, type 2 diabetes, hypothyroidism, malnutrition, and prior candidemia, who presented with a one-month history of intermittent non-productive cough. Imaging revealed multifocal pneumonia with large left and moderate right pleural effusions. Despite antibiotic therapy with Vancomycin and Piperacillin-Tazobactam, his overall condition remained poor, with profound malnutrition (BMI 17.5 kg/m²) and limited functional capacity. Pulmonology consultation considered bilateral thoracentesis; however, given his steeply declining health, dementia, and poor nutritional status, the family declined invasive interventions and opted for comfort-focused care. His family changed his code status to Do Not Resuscitate (DNR), and the palliative care team was consulted and provided symptom management, psychosocial support, and hospice transition planning. Conclusion: This case emphasizes the importance of collaborative decision-making and involvement of palliative care to ensure that management aligns with the patient's goals and overall health. Choosing to avoid invasive procedures and instead focus on comfort care can better reflect the patient's wishes and uphold the principles of autonomy, beneficence, and quality of life.

Lung cancer is the most prevalent cancer in the developed world and the most common cause of cancer-related deaths. Metastasis to the gastrointestinal tract is relatively rare from any primary cancer, and particularly from lung cancer. The most common site of metastases of lung cancer is to the adrenals, liver, bone, and brain. Although metastasis to the gastrointestinal tract remains rare, it is under-diagnosed, and is likely to increase in frequency as patients with primary lung cancer live longer with their disease and therefore suffer more sequelae of advanced disease.