Reddy Ramyashree N, Baikunje Nandakishore, Belur Giridhar, Nair Nandu
Internal Medicine, KS Hegde Medical Academy, Mangaluru, IND.
Pulmonary Medicine, KS Hegde Medical Academy, Mangaluru, IND.
Cureus. 2024 Jan 31;16(1):e53345. doi: 10.7759/cureus.53345. eCollection 2024 Jan.
A 59-year-old hypertensive woman presented with a year-long history of cough, expectoration, and progressive breathlessness, recently complicated by hemoptysis and significant weight loss. Initial investigations, including a chest x-ray and contrast-enhanced computed tomography (CECT) of the thorax, suggested an infective pathology. Despite negative bacterial, fungal, and tuberculosis cultures, elevated bronchoalveolar lavage (BAL) galactomannan and serum Aspergillus-specific IgG levels led to a diagnosis of invasive pulmonary aspergillosis (IPA), and antifungal treatment commenced. The patient's initial response was positive; however, symptoms recurred three months later. Further investigations revealed adenocarcinoma, confirmed by cytology from a thoracentesis. The patient, a non-smoker, began targeted therapy with tyrosine kinase inhibitors but declined further diagnostic evaluation. Despite the poor prognosis and palliative care options, the patient opted for discharge to home care. This case underscores the complexity of diagnosing lung pathologies and the importance of considering alternative diagnoses in persistent respiratory symptoms.
一名59岁的高血压女性患者，有长达一年的咳嗽、咳痰及进行性呼吸困难病史，近期并发咯血和明显体重减轻。包括胸部X线和胸部增强计算机断层扫描（CECT）在内的初步检查提示为感染性病变。尽管细菌、真菌和结核培养结果均为阴性，但支气管肺泡灌洗（BAL）半乳甘露聚糖升高及血清曲霉特异性IgG水平升高，导致诊断为侵袭性肺曲霉病（IPA），并开始抗真菌治疗。患者最初的反应是积极的；然而，三个月后症状复发。进一步检查发现腺癌，经胸腔穿刺细胞学检查确诊。该患者不吸烟，开始使用酪氨酸激酶抑制剂进行靶向治疗，但拒绝进一步的诊断评估。尽管预后不良且有姑息治疗选择，但患者选择出院接受家庭护理。该病例强调了诊断肺部疾病的复杂性以及在持续呼吸道症状中考虑其他诊断的重要性。
