Deadly metastatic adenocarcinoma of the lung presenting as isolated chronic cough for “3 months”: A cautionary tale

ABSTRACT

Background: Lung cancer is the leading cause of cancer death worldwide. Adenocarcinoma accounts for 38.5% of all lung cancer cases. Case Study A 70 year old nonsmoker female with chief complaints of dry cough since 3 months, no history of hemoptysis, chest pain, fever, weight loss, loss of appetite, jointpains, no past history of COVID-19. Chest X-ray showed bilateral nodular opacities.In view of persistent symptoms HRCT chest was done that revealed large nodular lesions and paraseptal emphysematous changes in the periphery of both lungs. PET scan was done with high index of suspicion of bronchogenic carcinoma with multiple bilateral lung secondaries that revealed multiple mass lesions in bilateral lungs with lymphangitis carcinomatosis, adrenal, skeletal and abdominal metastasis. CT guided biopsy from the mass lesion revealed adenocarcinoma. EGFR mutation was positive. Discussion: Lung cancer being the most common cause of cancer death warrants meticulous evaluation including chronic cough without constitutional symptoms. Conclusion: Initial clinical presentation and investigations can be deceptive. Patient should be re-evaluated if there is no improvement. Diagnosis of malignancy can be delayed due to low index of suspicion.