Case 26--New Radiographic Opacities in a Man with Chronic Lymphocytic Leukemia

Dr. Ellen Moffatt collaborated on this case.

Clinical summary: A 77-year-old man with chronic lymphocytic leukemia (CLL) diagnosed 12/6/98 presented 1/27/99 with cough productive of brownish sputum. The CLL was being treated with chlorambucil and prednisone. He had been admitted 1/16 for similar respiratory symptoms. At that time, physical examination showed T 100.4°, HR 100/min, and BP 110/67. Oxygen saturation was 91% on room air. The white blood cell count was 25.6 k/µl, with PMNs 3.6 k/µl and lymphocytes 20.7 k/µl. Anemia (hematocrit 28%) was treated with packed RBCs. He received antibiotics for presumed community-acquired pneumonia and then left the hospital against medical advice. At home, dry cough, fever, and fatigue persisted. In the oncology clinic on 1/27, radiographic changes and generalized anasarca were noted, and he was readmitted. Vital signs were normal. He had bibasilar crackles and decreased breath sounds in the LUL. The WBC count was 44 k/µl. BUN had risen to 55 mg/dl and creatinine was 1.7 mg/dl. He was treated with Levoflox and flagyl. Bronchoscopy on 1/30 yielded no diagnosis. He died on 2/1. Autopsy was limited to the lungs.

Radiology | Image 1 | Image 2 | Image 3 | Image 4 | Discussion

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