PMC8380831_01
Serial thoracic computed tomographies (CTs) that demonstrate the lesion migration. (A) Image before corticosteroid initiation. (B) Image after the initial short-term corticosteroid treatment. (C) Image at the time of the CT-guided biopsy. (D) Fine-needle biopsy (FNB) cutoff point.
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F1
Figures 1, 2 include the evolution of the lung imaging of the patient. CT-guided biopsy (Figure 1D) was conducted, which was suggestive of OP with mild chronic interstitial inflammatory infiltration and foci of foamy macrophages. Cortisone therapy was gradually declined and replaced, because of the age of the patient, osteoporosis, and cataract, with MMF without adverse events or relapses.
Serial thoracic X-rays that show the migration of the lesions. (A) Image on admission. (B) Picture after corticosteroid initiation as organizing pneumonia. (C) Picture 2 months after discharge.
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F2
Figures 1, 2 include the evolution of the lung imaging of the patient.
Characteristic pictures of the bone marrow biopsy. (A) Hypercellular bone marrow with panmyelosis (trilineage hyperplasia). (B) Diversity in nuclear morphology of the megakaryocytes (multi- or monolobated forms, irregular chromatin distribution). (C) Aggregates of immature myeloid precursors in the intertrabecular region (myeloperoxidase stain). (D) Abnormal localization of erythroblasts (some with megaloblastic features) on the endosteum of the trabecular bone (Glycophorin C stain).
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F3
MDS with multilineage dysplasia was diagnosed. More specifically, the BM showed a hypercellular picture because of hyperplasia of all three hemopoietic cell lineages (Figure 3A). As shown in the characteristic pictures in Figure 3, there was abundance of diversity in the nuclear morphology of the megakaryocytes (multi- or monolobated forms, irregular chromatin distribution), the aggregates of immature myeloid precursors in the intertrabecular region after myeloperoxidase stain, and the abnormal localization of erythroblasts (some with megaloblastic features) on the endosteum of the trabecular bone after Glycophorin C stain.
Timeline with relevant data from the episode of care.
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F4
Figure 4 summarizes the timeline of this case report.