Muhammad Ramzan, Talha Mahmud.
Co-Existent Epidermal Growth Factor Receptor Positive Metastatic Lung Adenocarcinoma with Pulmonary Tuberculosis.
Pak J Chest Med Jan ;22(2):73-7.

57-year-old male resident of Gilgit and worker at a medical dispensary was diagnosed to have pulmonary tuberculosis (PTB) and was on anti-tuberculous treatment (ATT) for 3 weeks. He had a 20 pack-years cigarette smoking history, without any medical co-morbid conditions. He came to emergency department with worsening of dyspnea, cough, sputum & weight loss and required oxygen inhalation to maintain saturation. His chest radiology revealed bilateral diffuse pulmonary nodules; current 3 sputa smears were negative for acid fast bacilli (AFB) and spirometry had restrictive pattern. Histopathology of transbronchial biopsies (under fluoroscopy) was consistent with metastatic lung adenocarcinoma and bronchial washings (negative for AFB staining) were positive for mycobacterium tuberculosis complex without resistance to rifampicin (GeneXpert MTB/Rif assay). Molecular analysis of biopsy tissue was positive for epidermal growth factor receptor (EGFR) mutation showing exon19 deletion. Besides continuing oxygen and ATT, tyrosine kinase inhibitor (TKI) drug erlotinib was started. He showed remarkable improvement in dyspnea, gained weight and was off oxygen for 12 months along with considerable radiological clearing of lesions. After one year, he was hospitalized again due to intractable dyspnea, respiratory failure and worsening in radiological shadows and passed away.

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