Adenocarcinoma of the Lung Masquerading As Invasive Pulmonary Aspergillosis in an Elderly Lady: A Diagnostic Challenge

A 59-year-old hypertensive woman presented with a year-long history of cough, expectoration, and progressive breathlessness, recently complicated by hemoptysis and significant weight loss. Initial investigations, including a chest x-ray and contrast-enhanced computed tomography (CECT) of the thorax, suggested an infective pathology. Despite negative bacterial, fungal, and tuberculosis cultures, elevated bronchoalveolar lavage (BAL) galactomannan and serum Aspergillus-specific IgG levels led to a diagnosis of invasive pulmonary aspergillosis (IPA), and antifungal treatment commenced. The patient's initial response was positive; however, symptoms recurred three months later. Further investigations revealed adenocarcinoma, confirmed by cytology from a thoracentesis. The patient, a non-smoker, began targeted therapy with tyrosine kinase inhibitors but declined further diagnostic evaluation. Despite the poor prognosis and palliative care options, the patient opted for discharge to home care. This case underscores the complexity of diagnosing lung pathologies and the importance of considering alternative diagnoses in persistent respiratory symptoms.