Tuberculosis Coinciding With Epidermal Growth Factor Receptor (EGFR)-Mutant Lung Adenocarcinoma: A Diagnostic Conundrum

Tuberculosis (TB) and lung carcinoma can coexist, creating diagnostic and therapeutic difficulties leading to poor patient outcomes, especially in a TB-endemic country like India. Here, we report an interesting case of a female patient in her 40s who presented with shortness of breath and a weight loss of 15 kg over 10 months. Her imaging findings include a right-sided pleural effusion, right parahilar lesion, and mediastinal lymphadenopathy. Medical thoracoscopy was done, and the pleural biopsy was positive for GeneXpert MTB. She responded initially to anti-TB therapy. However, she developed a new lytic lesion over the right proximal shoulder and a progression of her initial radiological findings. She was evaluated further, which revealed EGFR (epidermal growth factor receptor)-mutated lung adenocarcinoma. Hence, a diagnosis of coexistent TB and lung adenocarcinoma was made. She was lost to follow-up, and a telephonic call revealed she had died two years later.