Malignant Mesothelioma Manifesting in an Elderly Female without Occupational Asbestos Exposure

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.Sarah Steenson (1), Tarang Pankaj Patel (1), Satish Kalanjeri (2), Jeremy Carl Johnson (2) ; 1. Division of Pulmonary, Critical Care and Environmental Medicine, University of Missouri School of Medicine. 2. Division of Pulmonary, Critical Care and Environmental Medicine, Harry S Truman Veterans Affairs Hospital, University of Missouri School of Medicine.Includes bibliographical reference