CRA16 MASKING OFF AN UNDERLYING LUNG MALIGNANCY FROM AN INFECTION – A DISTRICT HOSPITAL EXPERIENCE

Syahrinnaquiah Samsuddin1, Syaza Naqibah Mohd Noor Rahim 1, Wan Jen Lye2.
1Medical Department, Hospital Kuala Kubu Bharu, Selangor
2Respiratory unit, Hospital Selayang, Selangor

Introduction:

Diagnosing lung malignancy can be challenging in district hospitals due to common respiratory and radiographic findings overlapping with pneumonia. Differentiating between these conditions is crucial as their treatment and prognosis differ. This case highlights the challenges in making diagnosis in a district hospital setting.

Case Report:

A 48-year-old Malay gentleman, an active smoker, presented with a week-long history of fever and cough. His chest radiography showed right upper zone consolidation with pleural effusion. Thoracocentesis revealed exudative pleural effusion and sputum cultures indicated Klebsiella pneumoniae. Despite antibiotics, his condition only slightly improved, with persistent consolidation on the chest radiograph. A subsequent CT Thorax revealed a right upper lobe mass. Bronchoscopy and cryobiopsy confirmed Squamous Cell Carcinoma (SCC), positive for p40 and negative for TTF-1. He was referred to oncology for chemotherapy.

Discussion:

Pneumonia can obscure underlying malignancy, particularly in district hospitals with limited access to advanced imaging. Symptoms like fever, cough, and shortness of breath common in pneumonia can also indicate lung malignancy. According to Mortensen et al., diagnosing lung malignancy from index pneumonia cases takes a median of 297 days. A high index of suspicion is essential, with follow-up chest radiographs and CT imaging when necessary to ensure timely referral to a tertiary center to assist in making a diagnosis.

Conclusion: 

Pneumonia masking underlying SCC poses significant diagnostic challenges, especially in resource-limited district hospitals. High suspicion, advanced diagnostic tools, and timely referrals to tertiary centers are crucial for accurate diagnosis and appropriate treatment.

Keywords:

Pneumonia, Squamous Cell Lung Carcinoma