A 62-year-old woman presented with a 3-month history of cough and hemoptysis. CT revealed nodular shadows with centrilobular distribution in the left lung. Three sputum smears for acid-fast bacillus were negative. Based on the results of a transbronchial biopsy, she was diagnosed with stage IVA lung lepidic adenocarcinoma harboring ALK translocation. At this point, CT showed progressive shadows, and alectinib was immediately initiated. Acid-fast bacillus culture of bronchoscopic biopsy tissue was negative. One month later, marked remission was observed, providing definitive evidence to exclude mycobacterial infection. The tree-in-bud pattern occurs commonly in patients with mycobacterial infection. Central lung cancer is reportedly another common cause of the treein-bud pattern. Nevertheless, when encountering a treein-bud pattern, physicians tend to be anxious about the possibility of tuberculosis; even when mycobacterial tests are negative, the absence of evidence is not evidence of ..... READ ARTICLE
Internal Medicine (The Japanese Society of Internal Medicine) DOI:10.2169/internalmedicine.4076-19
Authors: Takayuki Shiroyama, Shingo Nasu, Ayako Tanaka and Tomonori Hirashima