Small Cell Lung Cancer Mimicking Pulmonary Tuberculosis in a 22-Year-Old Man: A Diagnostic Challenge in a Tuberculosis-Endemic Setting

Vollständiger Abstract

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Small cell lung cancer (SCLC) is an aggressive neuroendocrine malignancy characterized by rapid progression and early metastasis. Its clinical and radiological manifestations may overlap with pulmonary tuberculosis, creating a diagnostic challenge in tuberculosis-endemic settings. This overlap may be particularly misleading in young adults, in whom primary lung malignancy is rarely suspected. Case Presentation: A 22-year-old man presented with a persistent cough, intermittent fever, and an unintentional weight loss of approximately 5–7 kg. Based on his clinical presentation and chest radiographic findings, he was initially diagnosed with clinically presumed pulmonary tuberculosis and received intensive-phase antituberculosis therapy. Despite a slight reduction in cough, his general condition and body weight did not improve. He subsequently developed unilateral cervical lymphadenopathy and swelling of the left cheek, left upper extremity, and both lower extremities. Histopathological examination of a cervical lymph-node biopsy revealed malignant cells, while computed tomography of the chest demonstrated a right lung mass, multiple lymphadenopathies, and pleural effusion. The patient underwent therapeutic thoracentesis, systemic chemotherapy, and supportive care. This case highlights the potential for SCLC to mimic pulmonary tuberculosis, even in a very young patient. Lack of meaningful improvement after empirical antituberculosis treatment, progressive lymphadenopathy, pleural effusion, or clinical deterioration should prompt immediate diagnostic reassessment. Integrating microbiological evaluation, cross-sectional imaging, and timely tissue biopsy is essential to reduce diagnostic delay and facilitate earlier oncological management.