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).