Lung Cancer: Lung Cancer |

Bilateral Consolidation Due to Lung Adenocarcinoma Simulating Community-Acquired Pneumonia (CAP) in a 23-Year-Old Nonsmoker Mother of a Seven Month Baby FREE TO VIEW

Mara Rubia Lima, MD; Paulo Teixeira, MD; Jackeline Souza, MD; Chariel Ciochetta; Fernanda Oliveira; Fernanda Rech; Gilcilene Lima; Olivia Bezerra; Manoela Klein, MD
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UFCSPA, Porto Alegre, Brazil

Copyright 2016, American College of Chest Physicians. All Rights Reserved.

Chest. 2016;149(4_S):A262. doi:10.1016/j.chest.2016.02.274
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SESSION TYPE: Case Report Poster

PRESENTED ON: Sunday, April 17, 2016 at 11:45 AM - 12:45 PM

INTRODUCTION: Lung adenocarcinoma usually occurs in male smoker patients after the 5th decade of life. Typical images are unilateral peripheral lesions invading pleura or causing bronchial obstruction. Scarcely adenocarcinoma simulates CAP, particularly in patients below 30 years, non-smokers and, occuring during pregnancy, is associated to high risk of death.

CASE PRESENTATION: 23 years old, nonsmoker, mother of a seven month baby. November 2013: during late pregnancy, cough, mucoid sputum and dyspnea, atributed to anti-influenza vaccine received this month. Denied chest pain, hemoptysis, fever and decided to wait child-birth in December to be treated, but only in January 2014 she started antibiotic with no improvement. Weight loss of 14 Kg in 6 months. Monthly repeated chest X-rays and changed antibiotics. June 2014: using Azithromicin and Cefuroxime, was admited in a terciary hospital with poor general condition, crackling rales and diffuse bilateral wheezing, O2 saturation: 85-90% under oxygen. Chest X-ray:Extensive billateral consolidation, pneumothorax on the right side. Computarized tomography (CT): billateral consolidation, especially in the lower lobes and basal portions of the upper lobes. Negative HIV Rapid Test and AFB search in sputum. Leukocytosis (21,580/mm3) with 17576 (83%) neutrophils, 1365 (5.4%) eosinophils, hemoglobinuria (+++). Negative serology for viral hepatites and HIV. Anatomopathology of lung sample obtained by transbronchial biopsy: adenocarcinoma with invasive focus in bronchial wall. Treated with Carbotaxol (negative EGFR gene excluded additional oral chemotherapy) for six months, she died in December 2014 due to sepsis secondary to KPC lung infection.

DISCUSSION: When an adenocarcinoma appears as consolidation is often misdiagnosed as CAP mainly if affecting a young nonsmoker patient. Although uncommon during pregnancy, lung cancer has a worse prognosis and a longer delay to be diagnosed because of a reluctance of both physician and patient to expose the fetus to radiation and take medication. In this case symptoms started during pregnancy, but adenocarcinoma was investigated with bronchoscopy after several months of therapeutic failure.

CONCLUSIONS: The lesson brought by this case is the need of bronchoscopy for differential diagnosis of pulmonary consolidations in cases of therapeutic failures, even in nonsmoking young patients, mostly if a pregnant woman.

Reference #1: Van Winter, JT; Wilkowske, MA; Shaw, EG; Ogburn Jr., PL; Pritchard, DJ. Mayo Clinic Proceedings April 1995 Volume 70, Issue 4, Pages 384-387 Lung Cancer Complicating Pregnancy: Case Report and Review of Literature

Reference #2: Kim L, Kim KH, Yoon YH, Ryu JS, Choi SJ, Park IS, Han JY, Kim JM, Chu IC Clinicopathologic and Molecular Characteristics of Lung Adenocarcinoma Arising in Young Patients -J Korean Med Sci. Sep 2012; 27(9):1027-1036.

Reference #3: SILVERMAN, G; ANGRIST, A. LOBAR ADENOCARCINOMA OF THE LUNG SIMULATING PNEUMONIA Report of Two Cases Arch Intern Med (Chic). 1948;81(3):369-380.

DISCLOSURE: The following authors have nothing to disclose: Mara Rubia Lima, Paulo Teixeira, Jackeline Souza, Chariel Ciochetta, Fernanda Oliveira, Fernanda Rech, Gilcilene Lima, Olivia Bezerra, Manoela Klein

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