A Case of Miliary Brain Metastasis of Lung Cancer Mimicking Neurocysticercosis.

Lee, Ho Jun; Oh, In Jae; Park, Sang Woo; Ban, Hee Jung; Kim, Young Chul; Kim, Soo Ok

doi:2012.72.2.182

Tuberc Respir Dis > Volume 72(2); 2012 > Article

Case Report

Tuberculosis and Respiratory Diseases 2012;72(2):182-186.
DOI: https://doi.org/10.4046/trd.2012.72.2.182 Published online February 1, 2012.

A Case of Miliary Brain Metastasis of Lung Cancer Mimicking Neurocysticercosis.

Ho Jun Lee, In Jae Oh, Sang Woo Park, Hee Jung Ban, Young Chul Kim, Soo Ok Kim

¹Department of Internal Medicine, Chonnam National University Medical School, Hwasun, Korea. droij@chonnam.ac.kr
²Department of Internal Medicine, Seonam University College of Medicine, Gwangju, Korea.

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.

Key Words: Neurocysticercosis, Neoplasm Metastasis, Brain, Gefitinib