CRA1 NOT JUST AN ABSCESS: CASE SERIES HIGHLIGHTING TUBERCULOSIS AND MALIGNANCY IN PULMONARY LESIONS

Shan Kai ING¹ MD, Nga Hung NGU¹ MD, Yih Hoong LEE¹ MD, Antony K² MD
¹Respiratory Unit, Department of Medicine, Sibu General Hospital, Ministry of Health Malaysia, Sibu, Sarawak, Malaysia.
²Department of Radiology, Sibu General Hospital, Ministry of Health Malaysia, Sibu, Sarawak, Malaysia.

Background
Lung abscess is typically associated with bacterial infections; however, it can occasionally mask or coexist with more serious underlying pathologies, including pulmonary tuberculosis (TB) and primary lung carcinoma. In TB-endemic regions, such overlap poses significant diagnostic and therapeutic challenges.

Objective
To highlight the importance of considering dual pathology in patients presenting with lung abscess through a case series involving coexisting pulmonary TB and lung carcinoma.

Methods
We present a retrospective case series of two patients admitted to Sibu and Kapit Hospitals between 2024 and 2025 with radiological evidence of lung abscess. Both underwent sputum analysis, bronchoscopy, microbiological studies (AFB smear, GeneXpert), and histopathological evaluation.

Results
Both patients were males with a significant smoking history (>20 pack-years). They presented with persistent cough, fever, and weight loss. Initial chest imaging revealed lung abscesses. Subsequent investigations confirmed pulmonary TB in both patients via microbiological testing and squamous cell carcinoma through histopathological analysis. Management included intravenous antibiotics, anti-tubercular therapy, and referral for oncologic evaluation. The coexistence of TB and carcinoma contributed to delays in diagnosis and necessitated a multidisciplinary treatment approach.

Conclusion
Lung abscess may serve as the initial clinical clue to underlying tuberculosis and malignancy. In areas with high TB prevalence and among high-risk individuals, clinicians should maintain a high index of suspicion for dual pathology when presentations are atypical or unresponsive to standard therapy. Prompt recognition and comprehensive evaluation are essential to ensure timely, targeted treatment and improved patient outcomes.