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Lee, Oh, Park, Ban, Kim, and Kim: A Case of Miliary Brain Metastasis of Lung Cancer Mimicking Neurocysticercosis
Case Report
Tuberculosis and Respiratory Diseases

Tuberculosis and Respiratory Diseases 2012; 72(2): 182-186.

Published online: 29 February 2012

DOI: https://doi.org/10.4046/trd.2012.72.2.182

A Case of Miliary Brain Metastasis of Lung Cancer Mimicking Neurocysticercosis

Ho-Jun Lee, M.D.1, In-Jae Oh, M.D.1, Sang-Woo Park, M.D.1, Hee-Jung Ban, M.D.1, Young-Chul Kim, M.D.1, Soo-Ok Kim, M.D.2

1Department of Internal Medicine, Chonnam National University Medical School, Hwasun, Korea.

2Department of Internal Medicine, Seonam University College of Medicine, Gwangju, Korea.

Address for correspondence: In-Jae Oh, M.D. Lung and Esophageal Cancer Clinic, Chonnam National University Hwasun Hospital, 322, Seoyang-ro, Hwasun 519-763, Korea. Phone: 82-61-379-7617, Fax: 82-61-379-7619, droij@chonnam.ac.kr

Received 1 October 2011       Revised 27 October 2011       Accepted 27 November 2011

Copyright © 2012. The Korean Academy of Tuberculosis and Respiratory Diseases. All rights reserved.

Abstract

Miliary brain metastasis from the lung is uncommon and has a poor therapeutic response. We report a case of pulmonary adenocarcinoma combined with multiple brain cystic lesions that were initially misdiagnosed as neurocysticercosis. A 53-year-old male who never smoked was admitted to our hospital with complaints of agitation and cognitive impairment. Brain magnetic resonance imaging showed innumerable, small nodular lesions with a central, low signal intensity in whole brain parenchyma. His symptoms were not improved by the empirical praziquantel medication for disseminated neurocysticercosis. After a transbronchial biopsy from the right middle lobe, we could diagnose the primary lung adenocarcinoma with a single nucleotide polymorphism in the epidermal growth factor receptor exon 20 at codon 787 (Q787Q). His neurologic symptoms and imaging findings have been gradually improving with a first-line Gefitinib treatment for five months. We recommend a more active diagnostic approach including biopsy in case of atypical imaging findings.

Keywords: Neurocysticercosis, Neoplasm Metastasis, Brain, Gefitinib

Figures and Tables

Figure 1
The initial chest X-ray shows multiple miliary nodular lesions in the lower right lung fields. (B) After 1 month of the gefitinib treatment, the lesions are remarkably improved on X-ray. (C) Chest CT shows irregular nodular interstitial thickenings and consolidations combined with innumerable tiny nodules in the right middle and lower lobes. (D) After 1 month of the gefitinib treatment, the lesions are remarkably improved on CT scan. CT: computed tomography.
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Figure 2
(A) The initial brain MRI of an outside hospital shows multiple cystic lesions with tiny scattered calcified nodules. (B) After 4 months, a follow-up MRI shows innumerable, small nodular lesions (up to 1.6 cm) with a central, low signal intensity in the whole brain parenchyma, suggestive of disseminated neurocysticercosis at the vesicular stage. (C) The cystic and nodular lesions are improved by a gefitinib treatment for 1 month. (D) The cystic and nodular lesions are improved by a gefitinib treatment for 5 months. MRI: magnetic resonance imaging.
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Figure 3
Direct sequencing showing the mutation found in the kinase domain of EGFR-2361G>A transition in exon 20, but this did not alter the final amino acids of glutamine at codon 787 (Q787Q). EGFR: epidermal growth factor receptor.
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