Week 430: Case 2

1. Presented by Peter Illei, M.D. and prepared by Hillary Ross, M.D.

26 y.o. white female with a history of primary refractory stage IVB classical Hodgkin disease diagnosed 10 months ago, status post ABVD x6 followed by ICE x2 with partial response. She was ultimately treated with a matched related donor sibling transplant with Bu-Cy prep. Starting 4 months ago, she has had a persistent cough, shortness of breath and fevers.

The patient presented to clinic with worsening shortness of breath and cough, and a CT scan revealed increase in size of nodular infiltrates in her bilateral lungs. Decision was made for her to be admitted for workup of these lesions.

CT chest - Increase in size of large patches, dense consolidation, ground-glass opacification predominantly involving the right lower lobe, medial left upper lobe, and left lower lobe. Findings compatible with worsening pneumonia. Numerous subcentimeter mediastinal lymph nodes and an anterior mediastinal mass, unchanged except for increased number of lymph nodes.

Chest x-ray - Minimal ill-defined alveolar infiltrate appearing in left lateral lung and alveolar infiltrate.