PROGRESSIVE CACHEXIA AND PATHOLOGIC SPINAL FRACTURE IN EARLY GASTRIC CANCER

초록

Background and aims Cancer cachexia is a multifactorial syndrome associated with weight loss, muscle wasting, and functional impairment, often leading to pathologic fractures. We present a case of progressive cancer cachexia with osteoporosis and a pathologic spinal fracture in a patient with early gastric cancer (EGC) and Mycobacterium kansasii infection. Methods A 66-year-old man with a 40-year smoking history presented in August 2024 with epigastricpain and weight loss. Endoscopy revealed gastric ulcer findings suggestive of EGC, and hewas diagnosed with CLO (+) EGC type IIB in September 2024. A lung cavitary lesion was identified and confirmed as Mycobacterium kansasii. He underwent Roux-en-Y gastrojejunostomy (T1b, MB, lesser curvature, type IIb, 4×4 cm) in December 2024. In February 2025, he experienced acute low back pain while bending forward. His weight had dropped from 54 kg to 40 kg (26% loss). Lumbar CT revealed an L1 fracture without metastasis. MRI showed a subacute burst fracture, PET scan revealed hypermetabolic activity in the L1 spine and lungs, and BMD confirmed severe osteoporosis (L1: -5.0, L2: -5.1, femur neck: -2.7). Functional assessments indicated muscle wasting and mobility impairment. Results The patient was diagnosed with progressive cancer cachexia and osteoporosis with a pathologic fracture. He showed improvement with high-calorie parenteral nutrition, osteoporosis treatment (Evenity), spinal bracing, and rehabilitation therapy. Conclusion This case highlights the impact of cancer cachexia on osteoporosis and fracture risk in gastric cancer patients. Early nutritional and bone health interventions are crucial for improving outcomes.