# 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.

## Key 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.