When doom is invincible and not easily perceptible: A case of diffuse nodular disease

Abstract

A 47-year-old -lady without known co-morbidity had presented with a one-month history of respiratory distress and headache. Someone incidentally started her with antitubercular drugs and steroids outside our hospital. Her routine CT scan of brain was unremarkable. She had a partial response to the same, but she presented to us with an increased headache after a month. We found her to have diffuse nodular pulmonary involvement with bilateral pleural effusion. The pleural fluid diagnostic evaluation revealed adenocarcinoma of the lung. The MRI of the brain revealed multiple nodular involvements consistent with the rare intracranial miliary metastasis. Our case underscores the importance of careful history taking and evaluation of patients with respiratory distress along with headaches (our patient lacked a classical history of miliary tuberculosis). We may overlook the silent brain metastasis on routine CT scans of the brain and cause an important delay in diagnostic evaluation and intervention in life-threatening diseases, like our case.