A 34-Year-Old Californian Surfer With a Right Upper Lung Mass

Abstract

INTRODUCTION: Haemophilus influenzae is a cause of pneumonia in COPD, rarely affecting patients with normal lungs. There has been only one case report describing H. influenzae mimicking lung cancer since 1990. CASE PRESENTATION: A 34-year-old Caucasian food business owner without prior medical problems was evaluated for a right upper lobe mass discovered on a chest radiograph performed because of nonspecific mild chest discomfort. He had no fever, night sweats, weight loss, cough or dyspnea. His physical examination was unremarkable and he never smoked. A CT scan of the chest with intravenous contrast demonstrated a heterogeneously-enhancing mass in the right upper lobe that measured 4.1 by 3.8 cm. Two bronchoscopies and a transthoracic needle aspiration were previously performed with inconclusive results. A culture of the lung lavage grew Mycobacterium gordonae. PET scan showed metabolic activity with SUV of 3.1.Transthoracic needle aspiration of the mass yielded beta-lactamase-negative H. influenzae. There were no malignant cells. Treatment with amoxicillin/sulbactam was initiated. A radiograph obtained after four months of therapy revealed complete resolution of the mass. DISCUSSION: Distinguishing lung infections from malignancy is difficult in young patients, although pulmonary infections mimicking cancer are rare. (1, 2). Clinical manifestations are cough, chest pain and the most common radiographic finding is a solitary pulmonary nodule. To our knowledge, this is the second case of an asymptomatic patient with a pulmonary mass mimicking lung cancer(3).Our patient was evaluated by multiple physicians from specialties such as infectious disease, internal medicine, interventional radiology to thoracic surgery at major medical centers from Los Angeles and Pittsburgh to New York City. Recommendations included repeat follow-up chest tomography and PET scan (nullwatch and waitnull), empirical treatment with antimycobacterial medications for tuberculosis or Mycobacterium avium complex, video-assisted thoracoscopic removal, and open thoracotomy with resection of the mass. However, the patient himself was adamant about a nonsurgical approach. CONCLUSIONS: Achieving a diagnosis of this lung mass with transthoracic needle aspiration and rapid onsite evaluation avoided surgical lung resection.