COUGH, FEVER, AND BILATERAL INFILTRATES ON IMAGING: WHAT CAN IT BE?

Abstract

TYPE: Case Report TOPIC: Lung Cancer INTRODUCTION: Lepidic-predominant adenocarcinoma (LPA), is a subtype of invasive adenocarcinoma, histologically characterized by bland pneumocytic-type neoplastic cells with growth along with normal structures. Radiologic pattern is variable; most typical appearance being part-solid nodule or mass. However, it can also present as segmental or lobar consolidation, with a multifocal or diffuse pattern. We present a case of LPA which was being treated as recurrent pneumonia due to its clinical and radiologic presentation. CASE PRESENTATION: 67-year-old non-smoker male, without medical comorbidities presented with worsening cough, wheezing, shortness of breath that initially started a year ago. He stated having intermittent episodes of low-grade fever with night sweats. Patient was treated with multiple courses of antibiotics and steroids throughout the year which would provide intermittent symptomatic relief. He denied hemoptysis, leg swelling or any other associated symptoms. Patient used to work in cotton fields and denied having birds or pets. Computed tomographic imaging of chest showed bilateral infiltrates with air bronchograms, consolidations with minimal ground glass opacities and nodular infiltrates with some showing evidence of cavitation. Laboratory data and bronchoscopic cultures were non-diagnostic. Open lung biopsy revealed lepidic-predominant adenocarcinoma. DISCUSSION: Diagnosing LPA might be challenging due to its varied and non-specific symptomatology. Suspicion should be high in patients with recurrent, ongoing symptoms that fail to resolve with multiple courses of antibiotics and steroids. Timely diagnosis is the key to successful therapy and thereby, early biopsy should be considered. CONCLUSIONS: LPA may mimic pneumonia radiologically and symptomatically. Early biopsy is the key to establish timely diagnosis in such patients. DISCLOSURE: Nothing to declare. KEYWORD: Lepidic-predominant adenocarcinoma