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Non-mucinous adenocarcinoma: a unique case with a deceptive presentation

Non-mucinous lepidic adenocarcinoma with pneumonic presentation is a rare form of lung cancer. Its ability to mimic infectious and inflammatory diseases in both patient presentation and diagnostic imaging can result in a delayed diagnosis. This case follows the workup of a 60-year-old non-smoker female who immigrated from Ecuador twenty years prior and worked at a shore repair shop for the past two years who presented with worsening shortness of breath and 15lbs weight loss over a two-month period. A unique aspect of this patient’s presentation was that the typical imaging and bronchoscopy findings often seen to distinguish this type of lung adenocarcinoma from other disease processes were absent. No nodular masses were observed on Computed Tomography (CT), and no lesions or airway abnormalities were seen on bronchoscopy. It was not until biopsy and bronchoalveolar lavage (BAL) that the diagnosis of adenocarcinoma was recognized. Our case aims to increase awareness among clinicians of the unpredictable presentation of nonmucinous lepidic adenocarcinoma. Furthermore, we want to highlight the relevance of including adenocarcinoma of the lung in the differential diagnosis even when infectious or occupational etiologies appear more likely.