Patient taking chemotherapy for a small cell lung cancer: not every cerebral nodule is a metastasis: the tree that hides the forest.
We report the case of a 53- year-old man in whom the diagnosis of small cell lung cancer (SCLC) was made by the biopsy of a mass of the right trapezius muscle. A tumor was revealed on flexible bronchoscopy which pathological study showed tuberculosis (TB). Chest computed tomography (CT) scan revealed findings related to the SCLC associated to micronodules and nodules compatible with pulmonary TB. Cerebral CT scan revealed a nodule of 4.5 mm in diameter presenting enhancement after contrast material injection thought to be a metastasis. The patient was administered antitubercular treatment. Fiveteen days later, the patient started chemoptherapy with etoposid and carboplatin. A control cerebral CT scan realized after the end of the chemotherapy (2 months and a half of antitubercular treatment) revealed numerous cortical and subcortical infracentimetric nodules with contrast enhancement with a tentorial and subtentorial location considered to be in relation with cerebral miliary TB. The nodule discovered on the first cerebral scan was therefore a posteriori considered to have been of tubercular origin. The PS of the patient rapidly worsened. He presented mental confusion and died in some days.
Ines
I
Zendah
Hela
H
Kammoun
Hamida
H
Kwas
Amel
A
Khattab
Aida
A
Ayadi
Asma
A
Zidi
Habib
H
Ghedira
D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D001932:Brain Neoplasms / Q000000981:diagnostic imaging / Q000556:secondary*; D003937:Diagnosis, Differential; D017809:Fatal Outcome; D006801:Humans; D008175:Lung Neoplasms / Q000150:complications / Q000188:drug therapy / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D011859:Radiography; D055752:Small Cell Lung Carcinoma / Q000150:complications / Q000188:drug therapy / Q000556:secondary*; D020306:Tuberculosis, Central Nervous System / Q000150:complications / Q000000981:diagnostic imaging*