Diagnostic Reevaluation of Persistent Asthma Reveals Underlying Pulmonary Carcinoid Tumor: A Case Report

Yogarajan R ¹, Jayakumari S ², Sumathi K ³, Mohan Kumar P R ^4*

This case showed the necessity of thorough diagnostic reevaluation in persistent asthma to uncover potential alternative diagnoses like carcinoid tumors.

Abstract

Background: A 50-year-old female patient with severe uncontrolled asthma was presented to our hospital for evaluation of anti-IgE therapy. Despite being on a comprehensive asthma management plan, including budesonide-formoterol combination, montelukast, and oral steroids, her symptoms of persistent dyspnea and wheezing continued unabated following a severe asthma attack five months prior. The case emphasizes the importance of reevaluating uncontrolled asthma to exclude other underlying conditions. Methods: The patient underwent a series of diagnostic evaluations, including chest X-ray, computed tomography (CT), and fiberoptic bronchoscopy. Imaging revealed a left-sided hilar opacity and an endobronchial lesion obstructing the left lower bronchus. The lesion was further assessed via CT, leading to a shift in diagnosis. The patient subsequently underwent a left lower lobe lobectomy and mediastinal lymph node dissection. Results: Pathological examination confirmed the diagnosis of a typical carcinoid tumor. Postoperatively, the patient's symptoms subsided, and she experienced no recurrence. Follow-up assessments indicated improved pulmonary function, and her asthma became well-controlled without the need for further aggressive treatment. Conclusion: This case highlights the need for a thorough evaluation in patients with severe, uncontrolled asthma, particularly when symptoms persist despite aggressive management. Clinicians should consider alternative diagnoses, such as carcinoid tumors, to ensure accurate diagnosis and effective treatment. Early detection and appropriate intervention are crucial in improving outcomes for patients with similar presentations.

Keywords: Uncontrolled asthma, Carcinoid tumor, Diagnostic evaluation, Pulmonary function, Asthma management

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