[Diagnostic difficulties caused by a pulmonary infiltrate].

Abstract

UNLABELLED:

Lung infiltration still causes differential diagnostic difficulties, which may delay the start of definitive treatment.

CASE REPORT:

The examination of a 30-year-old man began due intermittent, remittent and permanent fever. Chest X-ray confirmed infiltration in the right upper lobe, which was accompanied by elevated CRP and physiological levels of procalcitonin. Most likely atypical pneumonia, tuberculosis, Wegener's granulomatosis or a malignant process was suspected. Throughout his examination infection could not be verified, repeated CT guided transthoracic needle biopsy suggested the possibility of a malignant process. Through surgical exploration the intraoperative histology was not informative; thus, the pneumonitis-remodelled right lung was removed due to the possibility of malignant transformation. Histological examination revealed lymphocyte rich classical Hodgkin lymphoma, which was found to be stage IV/B based on the 18FDG-PET/CT scan; therefore, eight cycles of ABVD (adriablastin, bleomycin, vinblastine, and dacarbazine) therapy was administered successfully. The patient is currently (for 30 months) in a complete metabolic remission.

CONCLUSION:

Primary pulmonary Hodgkin lymphoma is a rare disease entity (in this case it might be the original process), in which the diagnosis is often difficult. 18FDG-PET/CT may be a useful early diagnostic tool investigating fever of unknown origin.

• Authors: Zsófia Simon, Adám Jóna, Zsófia Miltényi, Edit Páyer, Attila Lieber, Mária Szilasi, Arpád Illés
• Journal: Orvosi hetilap (Orv Hetil) Vol. 153 Issue 27 Pg. 1077-81 (Jul 08 2012) ISSN: 0030-6002 [Print] Hungary
• Vernacular Title: Diagnosztikai nehézséget okozó pulmonalis infiltrátum.
• PMID: 22759748 (Publication Type: Case Reports, Journal Article)

Chemical References

• Biomarkers, Tumor
• Fluorodeoxyglucose F18
• Bleomycin
• Vinblastine
• Dacarbazine
• Doxorubicin

Topics

• Adult
• Antineoplastic Combined Chemotherapy Protocols (administration & dosage, therapeutic use)
• Biomarkers, Tumor (blood)
• Biopsy (methods)
• Bleomycin (administration & dosage)
• Dacarbazine (administration & dosage)
• Diagnosis, Differential
• Doxorubicin (administration & dosage)
• Fever of Unknown Origin (etiology)
• Fluorodeoxyglucose F18
• Hodgkin Disease (blood, complications, diagnosis, drug therapy)
• Humans
• Lung (diagnostic imaging, pathology)
• Lung Neoplasms (blood, complications, diagnosis, drug therapy)
• Male
• Multimodal Imaging (methods)
• Positron-Emission Tomography
• Remission Induction
• Tomography, X-Ray Computed
• Treatment Outcome
• Vinblastine (administration & dosage)