A Case of Laryngeal Cancer with Bilateral Adrenal Hemorrhage Associated with Sepsis due to Radiation-Induced Mucositis That Showed a Rapidly Deteriorating Course

Abstract

Bilateral adrenal hemorrhage (BAH) is a rare but potentially fatal disease. BAH is associated with sepsis, antiphospholipid syndrome, use of anticoagulants, adrenal tumors, including metastases, or trauma/surgery in most cases. Mucositis induced by radiation therapy is a frequently occurring toxicity in patients with laryngeal cancer. However, it is rare for radiation-induced mucositis to be complicated by sepsis. We report the case of a 76-year-old man who was diagnosed as having laryngeal cancer (cT2N0M0), received radiation therapy, but suffered from septic shock and died immediately after the radiation therapy. Bacterial culture revealed the growth of Enterobacter cloacae from both the oral discharge and blood. Autopsy revealed severe mucositis, disseminated intravascular coagulation, and bilateral adrenal hemorrhage, and the patient was diagnosed as having died due to acute adrenal failure caused by bilateral adrenal hemorrhage.