Pulmonary pleomorphic carcinoma mimicking bronchopneumonia in an elderly man

A 77-year-old male smoker presented with fever, cough, and night sweat of 4 weeks' duration. Imaging of the chest revealed a left lung consolidation and a right cavitary lesion. Further investigation with flexible bronchoscopy supported the diagnosis of an infectious/inflammatory process. The patient clinically improved with antibiotics and was discharged. He was readmitted with a similar presentation 2 weeks later; at this time he had new onset of atrial fibrillation and worsening respiratory symptoms. After his heart rate was controlled, he underwent transthoracic needle aspiration and pleural fluid drainage, which again were nondiagnostic. A surgical biopsy was scheduled, but he expired before surgery. Necropsy revealed pulmonary pleomorphic carcinoma with invasion of both the lungs, lymph nodes, pericardium, and myocardium. Clinicians should keep a high index of suspicion for pleomorphic carcinoma in those patients with unusual presentation or progressive or nonresolving pulmonary infiltrates. Early surgical intervention, either for diagnosis or treatment, is imperative due to the aggressive nature of the tumor and the dismal prognosis.