Multiple large round well circumscribed pulmonary nodules in lungs are known as cannon ball secondaries. There are malignant and non-malignant causes of cannon ball secondaries. In case of malignancy, they represent classical haematogenous dissemination to the lungs of a primary malignant tumor. Secondaries to lung from renal cell carcinoma and choriocarcinoma are necrotic. The less common primary tumors causing cannon ball secondaries to lung includes prostate carcinoma, synovial sarcoma, endometrial carcinoma and some gastrointestinal malignancies. Here we presented a very rare case, maybe first of its kind of multiple cavitating cannon ball secondaries where primary malignancy was in lung itself which was EGFR positive adenocarcinoma lung. This case was also rare as cavitation is largely a feature of squamous cell carcinoma lung both of primary and metastatic lung malignancy.
Background: There are various types of cutaneous drug reactions with anti-tubercular therapy (ATT), and probably each and every first line ATT can manifest these reactions. Erythema multiforme (EM) is one of the extremely rare, acute hypersensitivity reaction to various drugs including pyrazinamide. Case Report: We report a case of 19 years old female with pulmonary tuberculosis who developed biopsy proven EM 45 days after initiation of ATT, as an adverse effect of pyrazinamide. Conclusion: Physicians must be aware of this rare side effect of pyrazinamide.
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