B80-5-20 When the Eyes Saw First: Pulmonary Adenocarcinoma Presenting as Blurring of Vision Without Respiratory Symptoms

Abstract Introduction In TB-endemic regions, distinguishing between tuberculosis and pulmonary malignancy can be difficult due to similar radiographic findings. Like many clinicians, we initially favored a common diagnosis—TB—when presented with the imaging. However, lung cancer can defy expectations, as shown by this case of pulmonary adenocarcinoma first presenting with visual disturbances. This scenario challenged our initial assumptions and reminded us to maintain diagnostic breadth. Case Description A 48-year-old woman with hypertension and diabetes presented with progressive, painless blurring of vision in both eyes, eventually declining to light perception. She denied cough, dyspnea, fever, weight loss, or other typical symptoms of lung disease. Ophthalmologic evaluation revealed bilateral choroidal lesions, and her complaints of left-sided chest pain and lower limb numbness prompted consideration of paraneoplastic syndromes. Complicating her history, she had been empirically treated for TB a year prior, based on chest radiograph alone, but this was discontinued due to severe drug reactions and hepatotoxicity. At no point did she develop respiratory symptoms, challenging our expectations.Chest CT later revealed near-total left lung collapse from bronchovascular encasement, right lung nodules, and bilateral adrenal and renal lesions. Bronchoscopy confirmed pulmonary adenocarcinoma (TTF-1+, Napsin A+, p40-). Discussion This case exemplifies how lung adenocarcinoma can challenge clinical assumptions, initially presenting as visual loss due to ocular metastasis in the absence of respiratory or constitutional symptoms. The simultaneous presence of ocular metastasis, paraneoplastic neuropathy, and airway obstruction is exceedingly rare. Our experience with this patient led us to question our initial impressions and to reconsider the likelihood of rarer diagnoses. In TB-endemic settings, reliance on imaging alone can obscure malignancy, and early tissue diagnosis with multidisciplinary collaboration becomes essential when the clinical picture does not fit usual patterns. This case serves as a reminder to maintain a high index of suspicion and embrace diagnostic uncertainty in complex presentations. This abstract is funded by: Myself