PMC5298528_01
Chest X-ray: acute onset of diffuse bilateral alveolar and interstitial opacities.
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Admission chest radiography showed new diffuse bilateral patchy alveolar and interstitial opacities (Figure 1).
Chest computed tomography scan on admission demonstrating diffuse nodular opacities with spiculated peripheral ground opacities (arrows) and bilateral lower lobe consolidation (arrow heads).
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On hospital day 2, chest CT revealed bilateral patchy consolidation and multiple enlarged axillary and mediastinal lymph nodes (Figure 2).
(A) Surgical lung biopsy (hematoxylin and eosin, 40x magnification) demonstrating lung parenchyma with focal dense lymphoid infiltrates (black arrows). Inset (100x magnification) composed of medium-sized cells with irregular nuclear contours, variably condensed chromatin, inconspicuous nucleoli, and moderate amount of cytoplasm. (B) Surgical lung biopsy (CD3 immunohistochemistry, 40x magnification) demonstrating a neoplastic aggregate of CD3 (+) cells (black arrows). The lymphoma cells were also positive for CD4, CD5, and CD7 and negative for CD8, CD30, ALK-1, and EBER.
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Histopathology revealed peripheral T-cell lymphoma, not otherwise specified (PTCL-NOS; Figure 3A and B).
Chest computed tomography scan after therapy. Resolution of nodular infiltrates with residual traction bronchiectasis and fibrosis from known nonspecific interstitial pneumonitis.
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Chest CT revealed interval improvement in pulmonary infiltrates and patchy consolidation (Figure 4), and the patient was extubated on hospital day 13 and discharged home on hospital day 28 with 3 liters per minute oxygen.