PMC6557744_01
Chest computed tomography before treatment showing right upper lung mass and diffuse small pulmonary nodules (A) as well as right axillary lymphadenopathy (B).
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A 76-year-old man with a 37.5 pack-year history of smoking was admitted to our hospital for the assessment of a right upper lung mass observed on chest CT (Fig. 1A). The chest CT also revealed right axillary lymphadenopathy and diffuse small pulmonary nodules (Fig. 1B), indicating extra- and intrapulmonary metastases.
Chest computed tomography after the first line chemotherapy showing an enlarged right axillary lymph node (A). After the fifth course of pembrolizumab, there are diffuse micronodules consistent with bronchiolitis (B). Histopathological findings of a lung biopsy specimen showing inflammatory cell infiltrates in the bronchioles (C) (Magnification x100).
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After four weeks of treatment, his chest radiography revealed rapid enlargement of a right axillary lymph node (Fig. 2A), suggesting progression of the lung cancer. Chest CT revealed diffuse micronodules (Fig. 2B), suggesting diffuse bronchiolitis. NSIP, DAD, or diffuse panbronchiolitis (DPB) (Fig. 2C). No bacteria, including acid-fast bacilli and Mycobacterium tuberculosis, were isolated from the
Chest computed tomography performed 6 months after discontinuing pembrolizumab showing a decrease in the size of the tumor as well as improvement in the bronchiolar micronodules after treatment for bronchiolitis.
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The lung mass decreased in size, and the micronodules suggesting bronchiolitis also improved (Fig. 3).