patient was a 74-year-old white man with a history of stage IV chronic
lymphocytic leukemia (CLL) diagnosed 6 years previously. The last cycle
of chemotherapy that he received was fludarabine 14 months prior to
admission. Additional history was significant for bouts of recurrent
bronchitis over the previous 6 months. One month prior to admission,
the patient presented with a persistent cough, and he was noted to have
a decreased hematocrit and platelet count. Chest CT done at that time
demonstrated increased subcarinal, mediastinal, and hilar adenopathy.
Therefore, a decision was made to restart fludarabine treatment. The
patient presented to the clinic 1 day after initiation of fludarabine
with complaints of severe cough that was productive of greenish-yellow,
blood-tinged sputum. He also complained of increased shortness of
breath, shaking chills, and fever to 38.8°C.