Recurrent Pneumonia? A Case of Availability Bias and Anchoring

Abstract

Invasive mucinous adenocarcinoma is a multi-centric adenocarcinoma that accounts for less than 5% of all lung cancer diagnoses. The most common presenting symptoms (cough, sputum production, and chest pain) in conjunction with its radiographic findings (patchy, multi-lobar infiltrates) make invasive mucinous adenocarcinoma challenging to distinguish from both infectious and inflammatory pneumonia. However, due to its aggressive nature, invasive mucinous adenocarcinoma should be considered if a presumed case of pneumonia lacks symptoms of infection (e.g., fever, leukocytosis) and/or does not respond to antibiotics. We report the case of a 75-year-old male who was admitted in the setting of a presumed case of recurrent pneumonia, which had failed to respond to prior antibiotic therapy. Further workup, including transbronchial biopsy, confirmed mucinous adenocarcinoma with a lepidic pattern. This case highlights the importance of establishing a broad differential in the setting of unresolved pneumonia following appropriate antibiotic coverage.

Systemic immune-inflammation index predicts survival in patients with resected lung invasive mucinous adenocarcinoma

“…Because of limited reported cases, there was no significant clinicopathologic prognosticator for pneumonic-type IMA, even the recognized TNM staging. For the relationship between pneumonic-type IMA and bad prognosis, a possible explanation is that the tumor mimic pneumonia on imaging, thus delaying diagnosis and treatment [ 28 , 29 ], but it still doesn't explain those patients still had a shorter survival time who accepted an undelayed operation. Systematic inflammatory response is a common accompaniment to pneumonic-type IMA, may lead to an elevated SII.…”