Tuberculosis Coinciding With Epidermal Growth Factor Receptor (EGFR)-Mutant Lung Adenocarcinoma: A Diagnostic Conundrum

TL;DR

A patient with tuberculosis and EGFR-mutant lung cancer faced diagnostic challenges, leading to a poor outcome despite initial treatment.

Contribution

Highlights the diagnostic complexity of coexisting tuberculosis and EGFR-mutant lung adenocarcinoma in a TB-endemic region.

Findings

Coexistence of TB and EGFR-mutant lung cancer can lead to misdiagnosis and delayed treatment.

Initial anti-TB therapy may mask underlying lung cancer progression.

Patient mortality occurred despite initial treatment response due to undiagnosed cancer progression.

Abstract

Tuberculosis (TB) and lung carcinoma can coexist, creating diagnostic and therapeutic difficulties leading to poor patient outcomes, especially in a TB-endemic country like India. Here, we report an interesting case of a female patient in her 40s who presented with shortness of breath and a weight loss of 15 kg over 10 months. Her imaging findings include a right-sided pleural effusion, right parahilar lesion, and mediastinal lymphadenopathy. Medical thoracoscopy was done, and the pleural biopsy was positive for GeneXpert MTB. She responded initially to anti-TB therapy. However, she developed a new lytic lesion over the right proximal shoulder and a progression of her initial radiological findings. She was evaluated further, which revealed EGFR (epidermal growth factor receptor)-mutated lung adenocarcinoma. Hence, a diagnosis of coexistent TB and lung adenocarcinoma was made. She was lost to follow-up, and a telephonic call revealed she had died two years later.

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