Adenocarcinoma with multiple metastases imitating neurocysticercosis and pulmonary tuberculosis

Abstract

Adenocarcinoma is the most common type of bronchogenic carcinoma in pediatric patients. It often has a poor prognosis, and stage 4 of the disease is observed in approximately 50% of the diagnosed cases. 1 We present the case of a 17-year-old female patient with a complaint of unproductive cough for 4 months, which intensified during exercises and air temperature changes. Intrusive cough, increased fatigue, and appetite and weight loss were observed. Chest X-ray revealed a right-sided pleural effusion. Drainage of the right pleural cavity was performed and Mycobacterium tuberculosis (Mbt) was detected in the exudate using polymerase chain reaction (PCR).Complete blood count (CBC): hemoglobin Z 133 g/L, red blood cells Z 4.0 Â 10 12 /L, white blood cells Z 6.9 Â 109/L, eosinophils Z 2%, neutrophils Z 72%, lymphocytes Z 15%, and erythrocyte sedimentation rate Z 58 mm/h.Due to an Mbt-positive PCR, the patient received tuberculosis treatment according to the protocol: isoniazid, rifampicin, streptomycin, B vitamins, and glucocorticoids. Nausea and vomiting appeared a month and a half after treatment initiation. These complaints were treated as pharmacological side effects and basic therapy was discontinued. Two weeks later, signs of central nervous system (CNS) damage developed (headache, insomnia, and meningeal symptoms), and brain magnetic resonance imaging (MRI) with chest computed tomography (CT) were performed (Fig. 1).MRI conclusion: diffuse lesions of the brain parenchyma and cerebellum of parasitic origin (neurocysticercosis).According to MRI and CT results, a differential diagnosis between neurocysticercosis, pulmonary tuberculosis, and lung tumor was made.