Case presentation by Alana Choy-Shan MD, Chief Resident
Welcome to the monthly posting of our NYU Department of Medicine’s Clinical Pathology Conference. Use the links below to review the case and the radiological findings. Our faculty and medical students will be attempting to diagnose this unknown case Friday 12/7/07 in the 17 West Conference Room at Bellevue Hospital. Feel free to make your diagnosis by clicking the comment field below. For those who are unable to attend the live conference, we will reveal the answer next week.
3 comments on “Clinical Pathology Conference 12/7/07”
This is the case of a 79-year-old man with ankylosing spondylitis, enphysema due to cigarettes smoking, dm2, hypertension and a chest ct scan that shows ground glass opacities, and pulmonary hypertension diagnosed through an ecocardiogram.
Causes of pulmonary opacities in immunocompromised hosts are:
opportunistic infections (bacteria of note is the fact that fluoroquinolones were ineffective in this patient, mycobacteria the sputum was negative, other mycobacteria non-tbc it might be a possibility, viruses what bothers me is the pulmonary hypertension that is not connected to a viral infection , micosis there was no epidemiological backgournd for such fungus as cocciodioidomycosis or histoplasmosis and cryptococus neoformas is highly unprobable as well as parasites), secondary to the underlying disease (AS produces an ILD that involves the upper lobes but the alveolitis in this patient was widespread) drugs ( I cannot recall any lung toxicity triggered by etarnecept, verapamil, hydrochlorotiazide, oral hypoglycemic drugs) aother disease (pulmonary emblism and chf were ruled out). causes of pulmonary hypertension (enphysema but he had alveolitis , primary hypertension not age or sex, ocnsumption of rapeseed oil not the case, vasculitis no clinical clues of SLE, RA, PSS, giant cell or granulomatous vasculitis: but why the mediastinal adenopathies?, antiphospholipid syndrome no pulmonary embolism was present, lymphoma intravascular would expplain the pulmonary hypertension and the alveolitis and the adenopathies a LDH measurement would have been helpful) My diagnosis: lymphoma due to compromised host defense secondary to etanercept
what about pcp in etanercept user? longer hx of symptoms though i guess. still, thought i’d throw it out there.
could be interstitial lung dis. ( RB -ILD ) associated with smoking or associaed with use of hydrochlorothiazide
pulmonary hypertension sec to COPD + typr II resp failure
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