PMC5540828_01
Chest x ray showing bilateral infiltrate and hilar adenopathy.
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Chest x ray showed possible pulmonary metastasis versus pneumonia (Fig. 1).
a: CT chest shows left lower lobe infiltrate (arrow) with right pleural effusion. b; CT chest showing the left lower lobe infiltrate. c: CT abdomen shows heterogeneity of the spleen due to granulomatous disease (arrow).
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Multiple lucencies surrounding the splenic calcifications were noted (Fig. 2a, b, c).
A. Hematoxylin & eosin stain (400x) Histiocytes (black arrow), neutrophils, lymphocytes, histiocytes (red arrow), and fibrin (green arrow) Figure 3b CD68 immunohistochemical antibody, DAB chromogen (400x) Stain (brown color) highlights histiocytes.
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Biopsy result showed chronic granulomatous inflammation with histocytes with no malignancy identified (Fig. 3a, b).
a: follow up chest CT shows resolution of the left lower lobe infiltrate, resolution of the left pleural effusion, notice the calcification of the left lower lobe (arrow). Figure 4b: follow up CT abdomen after Pembrolizumab has been stopped and patient has been shows remnant splenic calcification (arrow).
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One month follow up CT scan chest was done showed resolution of the pleural effusion and near complete resolution of the lower zone air space disease (Fig. 4 A, B).