CRA97 DIAGNOSTIC PITFALLS: LUNG ABSCESS CONCEALING AN UNDERLYING MALIGNANCY IN THE ELDERLY

Noor Eliana Rozani, Ahmad Adib Mohd Nasir, Nor Syamimi Mohd Isa, Haly Rozie Ahmad,Fatimah Azmah Mohammad, Noorul Adfiza Muhammad, Mona Zaria Nasaruddin, Kan Chan Siang, Leong Swee Wei

Hospital Sultan Idris Shah, Serdang, Selangor, Malaysia.

Introduction
Lung abscesses are commonly attributed to infections, but in high-risk elderly patients especially those with a history of smoking and structural lung disease, malignancy or tuberculosis should always be considered.

Case Report
A 74-year-old male, ex-smoker with multiple comorbidities, was admitted for coronary angiography. A lung abscess with features of empyema was incidentally found on CT angiography. Despite appropriate antibiotic therapy, imaging showed no improvement. The patient underwent right thoracotomy with decortication and lobectomy. Intraoperative findings and histopathology initially suggested tuberculosis, but GeneXpert for tuberculosis was negative. Final histopathology revealed moderately differentiated keratinizing squamous cell carcinoma.

Discussion
This case underscores the importance of maintaining a high index of suspicion for malignancy in elderly high risk patients presented with non-resolving lung lesions even when imaging suggests an infectious etiology. Early consideration of alternative diagnoses may allow for timely intervention and improved outcomes.