1. Presented by Peter Illei, M.D. and prepared by Robert E. LeBlanc, M.D.

74-year-old man with history of transformed Waldenstrom's macroglobulinemia, s/p non-myeloablative haploidentical transplant on protocol 16 month ago complicated by skin GVHD and colitis as well as reactivation HBV. Patient now presented with productive cough, fever and shortness of breath x 1 week. Multiple studies for infectious workup including cultures, histoplasma and legionella antigens were negative. Bronchoscopy was performed and the airways did not demonstrate significant inflammation or friability. He did have somewhat bloody return from the periphery which raised the specter of alveolar hemorrhage. BAL cultures and pneumocystis stains were negative. Patient underwent intubation and VATS biopsy.

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