Gunthiga Laplertsakul 1 - PowerPoint Presentation

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Gunthiga

Laplertsakul1, MD., Tananchai Petnak1, MD.1 Division of Pulmonary and Critical Care Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Thailand.

A 63-year-old man with NSCLC co-existing with localized pulmonary melioidosis: A Case Report

BACKGROUND

CASE PRESENTATION

CONCLUSION

1. Wilson M, Smith S, Brown J, Hanson J.

Melioidosis

mimicking primary lung malignancy with superior vena cava obstruction.

IDCases

. 2016;6:58-9.

2.

Yupin

Suputtamongkol WC, Ploenchan Chetchotisakd, Nimit Lertpatanasuwun. Risk Factors for Melioidosis and Bacteremic Melioidosis. by the Infectious Diseases Society of America. 1999;29:408-13.

In summary, this is the first case report of localized pulmonary melioidosis which is simultaneously diagnosed with primary lung cancer. The clue for diagnosis in this case is a prolonged fever which is not a usual manifestation of a primary lung cancer. Aerobic culture and culture for mycobacteria from tissue biopsy may have benefit to identify another pathology in the patient besides only pathologic diagnosis.

Patients with lung cancer usually present with cough, hemoptysis and shortness of breath. However, accidental abnormal chest radiograph without abnormal symptom is also common. Herein, we report a case of non-small cell lung cancer who presented with prolong fever. He was finally diagnosed as B. pseudomallei infection co-existing with primary pulmonary adenocarcinoma despite no history of diabetes. He was successfully treated with antimicrobial therapy and ongoing treatment for his cancer.

A 63-year-old Thai male presented with persistent fever and non-productive cough for 3 months. He lost his weight for 4 kg during 3 months of illness. Meropenem was prescribed for 14 days. However, fever was not resolved despite antibiotic therapy. He underwent deceased donor kidney transplantation 4 years ago due to chronic kidney disease. Physical examination showed an asthenic patient with anicteric sclera. His vital signs were revealed as body temperature of 38oc. His oxygen saturation was 95% at ambient air. Pulmonary examination revealed decreased breath sounds at left upper lung zone without crackles or egophony. Other examinations were unremarkable. Complete blood count showed white blood cells of 22 x 109/ml with 91% of neutrophils. Blood chemistry tests remained within normal ranges. He was performed chest radiograph and chest tomography. Results were showed in Fig.1 and Fig.2. Antibody titer for Burkholderia pseudomallei was positive in high titer (1:1,280). Hemoculture and serum cryptococcal antigen was negative. Transthoracic core needle biopsy was performed. Although the pathological result revealed adenocarcinoma of the lung, tissue culture grew for Burkholderia pseudomallei.

DISCUSSION

Even adenocarcinoma of the lung usually presents as a single mass, sometimes incidentally, on chest radiograph. There are some case reports about co-existing with infectious pathogen. The most common co-pathogen is

Mycobacterium tuberculosis

. Other pathogens have been reported as co-existing infection including Talaromyces marneffei and Entamoeba histolytica. In our case, patient was infected with melioidosis in the same period which malignancy had been diagnosed. Co-existing infection besides malignancy is suspected because of a history of fever of unknown origin. There is no proposed mechanism which explains why malignancy can be infected or it is just a coincidence.

REFERENCE

Fig. 2

pulmonary CT shows a large rim-enhancing mass with internal

hypodense

lesion at

apicoposterior

segment of the left upper lobe. (A,B)

In lung window, there is thickening of interlobular septa at left upper lobe.(C)

Fig. 1

Chest radiographs show well-defined large mass-like lesion on left upper lung zone(A). On lateral view(B) mass-like lesion on upper lung area, and

eventration

of right

hemidiaphragm.

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