Zhigang Chen

Lung adenocarcinoma remains a leading cause of cancer mortality globally. While immune checkpoint inhibitors (ICIs) have improved outcomes in advanced non-small cell lung cancer (NSCLC), their efficacy in patients with acquired epidermal growth factor receptor (EGFR) T790M mutations following multiline therapy is poorly defined. This case report describes a 52-year-old Asian female never-smoker diagnosed with stage IIIA lung adenocarcinoma. She underwent lobectomy and received multiple lines of therapy. Initial genetic testing showed no EGFR T790M mutation, but subsequent testing after multiline treatment confirmed its acquired presence. Following multiline therapeutic failure, the patient received immunotherapy with cadonilimab (a PD-1/CTLA-4 bispecific antibody). This intervention resulted in disease control, and the patient achieved 9.4 months of progression free survival (PFS). This case suggests that immunotherapy with cadonilimab could be a potential consideration for advanced NSCLC harboring acquired EGFR T790M mutation post-multiline therapy.

Background Nocardiosis is a rare opportunistic infection susceptible to immunocompromised patients. The condition frequently manifests as pulmonary infection and may have imaging characteristics which resemble to lung cancer, such as the nodules and the lymph nodes enlargement, leading to confusion in diagnosis. In addition, Nocardia can also spread through the blood, causing cutaneous and cerebral infections. Case presentation: We report a female patient with long-term oral methylprednisolone and ciclosporin, who had uncommon multiple systemic infections. CT scan showed the patient may be lung cancer with intrapulmonary, subcutaneous and musculature metastases, while the cranial enhanced MRI scan showed brain metastases. Finally, Nocardia was cultured through subcutaneous puncture fluid. After treatment, her multiple organ lesions became significantly smaller or subsided. Conclusions Doctors should consider nocardiosis as a potential infectious disease in patients with compromised immune systems to prevent incorrect diagnosis and treatment.