PMC8427237_01
(A) Chest X-ray at first presentation showing subtle nodular infiltrates in the right middle lung field. (B) Chest X-ray showing infiltration shadows in the right middle lung field in the beginning of December 2018. (C) Chest X-ray showing the expansion of infiltrating shadows in the right upper lung after 4 days of empirical intravenous antibiotic therapy.
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In July 2016, a 51-year-old woman was referred to our hospital because of chest abnormal shadows (Fig. 1A). She was subsequently diagnosed with pneumonia in the right upper lobe and hospitalized (Fig. 1B). Empirical intravenous antibiotic therapy was initiated with sulbactam/ampicillin, but the infiltrating shadows in the right upper lung field expanded (Fig. 1C).
(A) Chest computed tomography (CT) images at first presentation showing small nodular shadows and bronchiectasis in the right upper lobe. (B) Chest CT images showing ill-defined consolidation with neighboring granular shadows in the right upper lobe on the date of hospital admission. (C) Chest CT images showing reduction of the infiltrating shadows in the right upper lobe on the 29th hospital day.
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Chest computed tomography (CT) showed small nodular shadows and bronchiectasis in the right upper lobe (Fig. 2A). Chest radiography revealed infiltration shadows in the right upper lung field. Chest CT revealed ill-defined consolidation with neighboring granular shadows in the right upper lobe (Fig. 2B) and small nodule shadows in the middle lobe. After the triple antibiotics therapy, acid-fast bacilli smear of the sputum had been negative for three times, and chest CT on the 29th hospital day showed reduction of the infiltrating shadows in the right upper lobe (Fig. 2C).
Image of 18 fluorine fluorodeoxyglucose positron emission tomography/computed tomography showing intense fluorodeoxyglucose accumulation in the left breast tumor and left axillary lymph node metastasis.
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In November 2018, she was diagnosed with left breast cancer (cT1bN1M0, stage IIA) of menopausal status (Fig. 3).
Histological examination of the surgically resected specimen revealing granulomatous pneumonic lesions.
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Pathological examinations of the surgically resected specimen showed granulomatous pneumonic lesions (Fig. 4), but no bacteria by Ziehl-Neelsen staining; moreover, there was no evidence of a subsequent mycobacterial culture in the lung tissue.