Chest
Volume 126, Issue 4, October 2004, Pages 1368-1371
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Pulmonary and Critical Care Pearls
A Man With Interstitial Pneumonia and Pancytopenia During Radiotherapy

https://doi.org/10.1378/chest.126.4.1368Get rights and content

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Physical Findings

A physical examination revealed a pale, dyspneic, and cachectic man. His temperature was 38.5°C, heart rate was 105 beats/min, and oxygen saturation was 90% while the patient was breathing 100% oxygen by facemask. Scattered end-inspiratory crackles were heard all over the lung fields. The rest of the physical examination findings were within normal limits.

Laboratory Findings

A chest radiograph (Fig 1) revealed bilateral interstitial infiltrates. Laboratory results were remarkable for pancytopenia, and hemoglobin

Clinical Pearls

  • 1.

    The diagnostic approach to an immunocompromised patient with bilateral pulmonary infiltrates must be quick, based on the clinical context and local resources.

  • 2.

    The low yield of noninvasive procedures and the nonspecific nature of the clinical and radiologic findings often dictate an invasive approach that includes BAL followed by either TBB or OLB.

  • 3.

    Sporadic and classic RP are distinct clinical entities with different mechanisms and clinical presentations.

  • 4.

    Bilateral interstitial infiltrates

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Cited by (2)

  • Establishing nurse-led ventilator-associated pneumonia surveillance in paediatric intensive care

    2010, Journal of Hospital Infection
    Citation Excerpt :

    Adopting specific CXR changes in immunocompromised children as an essential criterion is debatable. Such children frequently present with diffuse pulmonary infiltrates related to non-infectious causes such as interstitial oedema, fibrosis, radiation pneumonitis, graft-versus-host disease or chemotherapeutic/other drug reactions, and distinguishing new VAP infiltrates can be unfeasible.31,32 Although this might account for lack of VAP in the immunocompromised, on review no patient in this group was clinically thought to have VAP.

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