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A Case of Miliary Adenocarcinoma of Lung Masquerading as Miliary Tuberculosis

Case report

Author

Abstrak

Adenokarsinoma paru-paru miliari adalah sangat jarang dan agresif. Adenokarsinoma paru-paru biasanya menunjukkan sifat ketulan pada peparu yang berkaitan dengan kerosakan paru-paru dan efusi pleura. Adenokarsinoma ini jarang jarang berpunca daripada tapak selain daripada tapak primer, tidak seperti kanser-kanser lain contohnya kanser tiroid, koriokarsinoma dan sarcoma. Kami membentangkan di sini kes seorang suri rumah berusia 50 tahun yang mengadu batuk-batuk, hilang selera makan dan sukar untuk bernafas selama 1 bulan. Perawat perubatan primer telah merawat beliau sebagai jangkitan kuman pada paru-paru. Disebabkan keadaan yang tidak pulih dan semakin melarat, beliau dibawa ke Jabatan Kecemasan. Oksigen beliau dikesan sebanyak 93% atas udara bilik. Berdasarkan sejarah pesakit dan penemuan X-ray paru-paru, rawatan untuk tuberculosis miliari telah di beri walaupun ujian Mantoux dan kahak negatif. Berikutan peningkatan tanda-tanda dan intubasi, bronkoskopi kemudian mendedahkan diagnosis adenokarsinoma paru-paru. Sebagai pelajaran, penampilan miliari radiografi tidak dikelirukan kepada tuberkulosis sahaja, kerana sebab-sebab berbahaya yang lain perlu disiasat. Bronkoskop dengan analisis histopatologi diperlukan, terutamanya jika Mantoux dan sputum adalah negatif.

Abstract

Miliary lung adenocarcinoma is a highly deceptive and insidious form of cancer.  It commonly presents as a mass lesion accompanied with a collapsed lung and significant pleural effusion. Adenocarcinoma presenting in this manner rarely originates from other primary sites such as thyroid, choriocarcinoma, and sarcomas. This was a case of a 50-year-old housewife, who presented with increasing severity of shortness of breath, cough and loss of appetite for the past one month. Primary care physician treated her as community-acquired pneumonia, which did not improve. She then arrived at the Emergency Department with pulse oximetry to be 93% on room air. She was slightly tachycardic. Bilateral widespread miliary patches were seen on chest radiograph. Based on the history and chest X-ray, she was initially treated for miliary tuberculosis, despite negative Mantoux and negative sputum. Following worsening of symptoms, she was intubated and admitted to the intensive care unit. Bronchoscopy revealed the diagnosis of primary miliary lung adenocarcinoma. As a lesson, the radiographic miliary appearance is not confounded to tuberculosis alone, as other insidious causes should be investigated. A bronchoscope with histopathology analysis is warranted for miliary picture, especially if the Mantoux and sputum turn out to be negative.