PMC7082228_01
CT of the chest with contrast medium, arterial phase, coronal view. Irregular, thickened peribronchium with narrowing of the lumen of segmental and subsegmental bronchi, fibrosis (marked with arrows) with compensatory dilation of the bronchial lumen (bronchiectasis), signs of bronchiolitis in PS10 and LS 10, irregular nodules in LS9 and LS10, a trace of fluid in the pericardium, enlarged right upper paratracheal, below carina, paraaortic, perivascular lymph nodes.
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F1
With the concern of severe respiratory infection (Figure 1) and sepsis in an immunocompromised patient, initial empiric pharmacotherapy was based on broad spectrum antibiotics meropenem and vancomycin, Pneumocystis jiroveci prophylaxis with cotrimoxazole, and antiviral and antimycotic medications acyclovir and fluconazole.
CT of the abdomen with contrast medium, arterial phase, axial, and coronal views. Hypodense foci in the II and VIII segments of the liver, enlarged spleen, ca. 14 cm long with nonhomogenous attenuation, hypoplastic left kidney, lymphadenopathy of lymph nodes in the regions of the head of the pancreas, portal vein, right renal hilum, inferior vena cava (marked with arrows), and retroperitoneal, iliac and aortic lymph nodes, forming a mass 8.5 cm long.
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F2
Subsequently, however, the boy's state deteriorated, febrile episodes returned, and exacerbation of the supraclavicular and abdominal lymphadenopathy was observed (Figure 2).