PMC9843483_01
Chest radiograph on admission. Chest radiograph shows diffuse consolidation in both lower lobes.
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A chest radiograph showed diffuse consolidation in both lower lobes (Fig. 1).
HRCT on admission. HRCT reveals bilateral craniocaudally and horizontally diffuse ground glass opacity accompanied by a mosaic pattern, and thickening of interlobular septa and bronchial walls (A, B). Air trapping in expiratory CT (C) and enlarged hilar and mediastinal lymph nodes in the mediastinal window setting CT (D) are also observed. HRCT: high-resolution computed tomography.
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Thickened interlobular septa and bronchial walls were noted (Fig. 2A and B). Air trapping in expiratory CT (Fig. 2C) and enlarged hilar and mediastinal lymph nodes in the mediastinal window setting CT (Fig. 2D) were also observed.
Pathological findings of the cryobiopsy sample from the right B8b. A sample of bronchioles and surrounding alveoli was obtained from the right B8b. The hematoxylin and eosin-stained section reveals severe infiltration of atypical lymphocytes with irregularly shaped and chromatin-dyed nuclei in the bronchiole walls, and the narrowed bronchial lumen (A, B). Immunostaining is positive for CD3 (D), CD4 (E), and CD5 (F), but negative for CD7, CD8, and CD20. Boat-shaped cyst forms of Pneumocystis in the Grocott-stained slice are also observed (C).
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A cryobiopsy sample of the right B8b indicated severe infiltration in the bronchiole walls by atypical lymphocytes with irregularly shaped and chromatin-dyed nuclei, and the bronchial lumen was narrowed (Fig. 3A and B). Immunostaining of lymphocytes was positive for CD3 (Fig. 3D), CD4 (Fig. 3E), and CD5 (Fig. 3F) but negative for CD7, CD8, and CD20. Pneumocystis (Fig. 3C). Pneumocystis jirovecci polymerase chain reaction was 1 x 106 copies/mL (>4 x 10) in bronchoalveolar lavage fluid from the right B5.
Clinical course of the patient. The patient was transferred from the respiratory medicine department to the hematology department on day 8, and the first course of THP-COP was started on the next day. The patient no longer required supplemental oxygen after day 12. THP-COP: pirarubicin, cyclophosphamide, vincristine, and prednisolone, WBC: white blood cell, LD: lactate dehydrogenase, mPSL: methylprednisolone, PSL: prednisolone, SpO2: saturation of percutaneous oxygen, RA: room air.
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The clinical course of the patient is shown in Fig. 4.
HRCT after initiation of treatment. HRCT on day 15 reveals improvement of the diffuse ground glass opacity (A) and reduced size of the enlarged lymph nodes (B). HRCT: high-resolution computed tomography.
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