EGFR-mutated lung adenocarcinoma presenting as miliary intrapulmonary carcinomatosis: A diagnostic mimic of tuberculosis.
- 1Texas A&M University Naresh K. Vashisht College of Medicine, Round Rock, TX, USA.
- 2Baylor Scott & White Medical Center, Round Rock, Round Rock, TX, USA.
Abstract
Miliary intrapulmonary carcinomatosis (MIPC) is a rare metastatic pattern of lung cancer that closely mimics disseminated tuberculosis (TB), posing a significant diagnostic challenge. We present a 53-year-old Filipino woman, a lifelong nonsmoker with prior latent TB, who presented with progressive cough and a diffuse bilateral miliary nodular pattern on chest imaging. An extensive infectious workup was unrevealing, and bronchoscopic biopsy revealed poorly differentiated adenocarcinoma (TTF-1+) harboring an EGFR exon 21 L⁸⁵8R mutation. Staging demonstrated brain, osseous, and pleural metastases (stage IVB NSCLC). The patient was initiated on osimertinib 80 mg daily with palliative radiation and zoledronic acid, achieving no evidence of active disease at 2.5 years on serial PET-CT and brain MRI. This case underscores the importance of tissue diagnosis in unresolved miliary patterns, early molecular profiling in lung adenocarcinoma, and the potential for durable exceptional responses with osimertinib in EGFR-mutated NSCLC.
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BibTeX
@article{paletta2026egfrmutated,
title = {{EGFR-mutated lung adenocarcinoma presenting as miliary intrapulmonary carcinomatosis: A diagnostic mimic of tuberculosis.}},
author = {Gianpiero Paletta and Srujan Kancharla and Alexis Magre and Naveen Tyagi},
journal = {Respiratory medicine case reports},
year = {2026},
month = oct,
doi = {10.1016/j.rmcr.2026.102502},
url = {https://europepmc.org/article/MED/42904154},
note = {CC BY},
}
RIS
TY - JOUR
TI - EGFR-mutated lung adenocarcinoma presenting as miliary intrapulmonary carcinomatosis: A diagnostic mimic of tuberculosis.
AU - Gianpiero Paletta
AU - Srujan Kancharla
AU - Alexis Magre
AU - Naveen Tyagi
PY - 2026
DA - 2026/10/02
JO - Respiratory medicine case reports
DO - 10.1016/j.rmcr.2026.102502
UR - https://europepmc.org/article/MED/42904154
AB - Miliary intrapulmonary carcinomatosis (MIPC) is a rare metastatic pattern of lung cancer that closely mimics disseminated tuberculosis (TB), posing a significant diagnostic challenge. We present a 53-year-old Filipino woman, a lifelong nonsmoker with prior latent TB, who presented with progressive cough and a diffuse bilateral miliary nodular pattern on chest imaging. An extensive infectious workup was unrevealing, and bronchoscopic biopsy revealed poorly differentiated adenocarcinoma (TTF-1+) harboring an EGFR exon 21 L⁸⁵8R mutation. Staging demonstrated brain, osseous, and pleural metastases (stage IVB NSCLC). The patient was initiated on osimertinib 80 mg daily with palliative radiation and zoledronic acid, achieving no evidence of active disease at 2.5 years on serial PET-CT and brain MRI. This case underscores the importance of tissue diagnosis in unresolved miliary patterns, early molecular profiling in lung adenocarcinoma, and the potential for durable exceptional responses with osimertinib in EGFR-mutated NSCLC.
SN - 2213-0071
ER -