Primary Lung Adenocarcinoma Manifesting as Bilateral Reticulonodular Infiltrates: A Case Report

TL;DR

A 52-year-old woman with no smoking history was diagnosed with lung adenocarcinoma after presenting with unusual lung symptoms and bilateral infiltrates.

Contribution

Highlights the importance of early bronchoscopy in diagnosing atypical lung cancer cases without traditional risk factors.

Findings

Lung adenocarcinoma was confirmed via bronchoscopy despite no smoking history or typical exposures.

Bilateral reticulonodular infiltrates were observed on CT imaging, mimicking other pulmonary conditions.

A solitary brain lesion was identified, influencing the patient's oncologic treatment plan.

Abstract

A 52-year-old female with a history of gastroesophageal reflux disease (GERD), hypertension (HTN), and supraventricular tachycardia (SVT) status postablation presented with progressive dyspnea and diffuse bilateral infiltrates on imaging. Symptoms began following exposure to a chicken farm, initially as a dry cough, evolving despite treatment with antibiotics, albuterol, and methylprednisolone. Emergency department CT imaging demonstrated bilateral linear, reticular, and nodular infiltrates. A negative infectious workup prompted bronchoscopy, confirming lung adenocarcinoma via immunohistochemical staining despite no significant smoking history, international travel, or other exposures. Brain MRI identified a solitary 7-mm enhancing lesion, guiding subsequent oncologic management. This case underscores the complexity of diagnosing atypical pulmonary symptoms and advocates for early bronchoscopic evaluation in suspected malignancies, particularly with pertinent family history.

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