Discussion
Lung cancer is the most common cancer diagnosis worldwide with a high
rate of mortality. Lung adenocarcinoma a non-small cell lung cancer is
the most common histological subtype with non-specific symptoms and
outcomes. Early diagnosis and treatment are critical in patients’
outcomes and survival (8).
Miliary TB is a lethal state of tuberculosis in immunosuppressed
patients with widespread dissemination of Mycobacterium even in the
brain. Various symptoms can be present due to the site of involvement.
Diagnosis is complicated due to the non-specific radiograph findings
(9).
Chest CT scan is a critical tool in LA diagnosis while it can appear
differently, mimicking non-malignant and infectious diseases (10).
Miliary shadows on imaging can appear in different diagnoses, especially
in infectious diseases such as miliary TB and histoplasmosis. Metastatic
primary and secondary lung cancers can also present as miliary nodules
(11).
In TB endemic areas such as our country, it is always critical to treat
patients with non-specific symptoms and miliary shadows on chest imaging
as miliary TB cases while further evaluations are necessary for the
proper diagnosis. Miliary nodules in chest imaging are a rare finding in
LA, while probable. We have to consider LA as an important differential
diagnosis in those with miliary shadows because it has a bad prognosis
in late diagnosis. Like our patient, several cases have been reported to
be LA, while their initial diagnosis was miliary TB (7, 11, 12).