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Pulmonary and Critical Care Pearls |

A Patient With Myelodyplastic Syndrome, Pulmonary Nodules, and Worsening Infiltrates*

Juliette L. Wohlrab, MD; Eric D. Anderson, MD, FCCP; Charles A. Read, MD, FCCP
Author and Funding Information

*From the Division of Pulmonary and Critical Care Medicine, Georgetown University Medical Center, Washington, DC.

Correspondence to: Juliette L. Wohlrab, MD, Division of Pulmonary and Critical Care Medicine, Georgetown University Medical Center, B100 Kober-Cogan, 3800 Reservoir Rd, NW, Washington, DC 20007; e-mail: wohlrabj@aol.com



Chest. 2001;120(3):1014-1017. doi:10.1378/chest.120.3.1014
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A 63 -year-old white man with stage IIA Hodgkin disease and myelodysplastic syndrome was admitted to the hospital with fevers and chills. The Hodgkin disease was diagnosed 3 years previously, and he received treatment with MOPP/ABV (nitrogen mustard, vincristine, procarbazine, prednisone, doxorubicin, vinblastine, bleomycin). The myelodysplastic syndrome developed 1 year prior to hospital admission and was thought to be secondary to his chemotherapy. His medical history was also significant for bronchiolitis obliterans organizing pneumonia (BOOP) diagnosed 2 years earlier using transbronchial biopsy. The BOOP responded to steroids, but diffuse infiltrates subsequently developed during treatment. Open-lung biopsy results showed Pneumocystis carinii pneumonia, which resolved after treatment with trimethoprim/sulfamethoxazole. Prior to hospital admission, the patient was noted to have new bilateral pulmonary nodules on surveillance CT, for which he was scheduled to undergo CT-guided biopsy. He was asymptomatic from a pulmonary standpoint and had no localizing infectious symptoms to account for his fever. Medications prior to hospital admission included dexamethasone, 4 mg/d; folic acid; filgrastim; aminocaproic acid; and omeprazole. He also received periodic platelet and RBC transfusions.

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