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Pulmonary and Critical Care Pearls |

A Man With Interstitial Pneumonia and Pancytopenia During Radiotherapy*

Nimrod Maimon, MD; Leonid Barski, MD; Netta Sion-Vardy, MD; Yaniv Almog, MD
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*From the Medical Intensive Care Unit (Drs. Maimon, Barski, and Almog) and the Department of Pathology (Dr. Sion-Vardy), Soroka University Medical Center, Faculty of Health Sciences, Ben-Gurion University, Beer-Sheva, Israel.

Correspondence to: Yaniv Almog, MD, the Medical Intensive Care Unit, Soroka University Medical Center, POB 151, Beer-Sheva 84101, Israel; e-mail: almogya@bgumail.bgu.ac.il



Chest. 2004;126(4):1368-1371. doi:10.1378/chest.126.4.1368
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Extract

A 61-year-old man with carcinoma of the lung presented with a 1-week history of worsening dyspnea, nonproductive cough, and fever (ie, temperature of up to 39°C), while still receiving radiotherapy. Six months earlier, he had received a diagnosis of stage IV non-small cell carcinoma. He had received six courses of chemotherapy, which included cisplatin and etoposide, with partial response. Chemotherapy was followed by radiotherapy to the mediastinum and right middle lobe. The total dose was 5,400 cGy, consisting of 4,140 cGy in 23 fractions, and a boost to the tumor bed of 1,260 cGy in 7 fractions. Toward the end of his radiotherapy, the patient began experiencing worsening dyspnea associated with fever and dry cough. His medications included oral dexamethasone, 2 mg daily, which was started in preparation for radiotherapy to the brain.

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