Unmasking Lepidic Adenocarcinoma in a COPD Patient: Overlapping Features with Inflammatory Etiologies

homogeneous opacities suggestive of an infective or inflammatory process (Fig. 1).Initial laboratory investigations showed elevated C-reactive protein (32 mg/dL), leukocytosis (16.4 × 10⁹/L) with neutrophilic predominance (85%), while the remaining routine investigations were within normal limits.Sputum samples were sent for bacterial culture and sensitivity, acid-fast bacilli (AFB) smear, and cartridge-based nucleic acid amplification test (CBNAAT).Considering the clinical presentation and inflammatory markers, the patient was managed as an infective exacerbation of COPD with intravenous ceftriaxone, azithromycin, nebulized bronchodilators, corticosteroids, and supportive care.However, sputum culture revealed only normal respiratory flora, while AFB smear and CBNAAT were negative.Truenat testing for influenza and COVID-19 was also negative, making an infectious etiology less likely.In view of the atypical presentation and negative microbiological investigations, contrast-enhanced computed tomography (CECT) of the thorax was performed.It revealed multiple irregular softtissue nodules with spiculated margins and surrounding groundglass opacities involving both lungs, along with a few enlarged enhancing mediastinal lymph nodes.The lesion also appeared to involve the parietal pleura, favoring a malignant etiology with radiological staging of T3N1M0 (Fig. 2).The combination of multifocal nodules and surrounding ground-glass opacities broadened the differential diagnosis to include atypical infection, organizing pneumonia, inflammatory lung disease, and primary lung malignancy.3,4 Flexible bronchoscopy did not reveal any endobronchial abnormality.Bronchoalveolar lavage (BAL) samples were obtained for microbiological analysis and cytological examination.BAL culture remained sterile, CBNAAT was negative, and cytology was inconclusive.