1Department of Neurology, Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia
2Department of Neurology, Dr. Soetomo General Academic Hospital, Surabaya, Indonesia
Corresponding author*
Djohan Ardiansyah, dr., Sp.N, Subsp. N-Onk(K)
Department of Neurology, Faculty of Medicine, Universitas Airlangga/ Department of Neurology, Dr Soetomo General Academic Hospital, Jalan Prof. Dr. Moestapo No. 6-8, Surabaya, Indonesia 60286
Email: djo1706@yahoo.co.id
Background: Calcified miliary brain metastasis represents an exceedingly rare manifestation of intracranial spread, characterized by diffuse micronodular involvement of perivascular spaces.
Case presentation: We reported a 49-year-old male with EGFR-mutant lung adenocarcinoma who developed progressive cognitive and motor deterioration after one year of Afatinib therapy. Initial MRI showed multiple hyperintense lesions throughout the cerebral and cerebellar parenchyma. Follow-up computed tomography five months later revealed numerous diffusely distributed calcified nodules involving the cerebral hemispheres, cerebellum, and midbrain, consistent with progressive calcified miliary metastases.
Conclusion: This case illustrates an uncommon radiologic evolution of miliary metastasis during EGFR–tyrosine kinase inhibitor therapy. Calcification likely reflects a complex interplay of treatment-related necrosis, hypoxic microenvironments, metabolic derangements, and clonal tumor resistance. Awareness of this pattern is critical when evaluating new neurological deficits in patients receiving targeted therapy.
Keywords: Lung adenocarcinoma; EGFR mutation; Brain metastasis; Calcified metastasis; Miliary pattern; Afatinib.
How to cite this article: Rizkiah IS, Al Adawiyah R, Ardiansyah D. Calcified Miliary Brain Metastases in Afatinib-Treated EGFR-Mutant Lung Adenocarcinoma. Int J Drug Deliv Technol. 2026;16(7s): 609-612; DOI: 10.25258/ijddt.16.7s.64
Source of support: Nil.
Conflict of interest: None