PMC6327904_01
Noncontrast chest computed tomography taken 5 months prior to admission (A) and on admission (B). Representative axial image demonstrate the diffuse nodular infiltration with inter- and intra-lobular septa or subpleural area.
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High-resolution chest CT (HRCT) revealed bilateral diffuse well-defined 1-2 mm of small granular shadow along with thickened interlobular septa, consistent with perilymphatic distribution (Fig. 1).
Lung biopsy samples. Section from trans-bronchial lung biopsy. (A): Notable lymphocyte aggregation in interstitium along with lymphatic duct positive for D2-40 (B). Most lymphocytes are positive for CD8 (C) and negative for CD4 (D).
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Given the lack of any evidence of pulmonary infection or any exposure to the stimulants of hypersensitivity pneumonia, an immune reaction to pembrolizumab was suspected and transbronchial random lung biopsy from the left upper lobe anterior segment and the left lower lobe anterior basal segment was performed (see Fig. 2).