Cryptogenic organising pneumonia
Admitted with CAP poorly responsive to oral antibiotics. Three month history fevers, LOW and left chest pain.
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Spiculated pleurally-based mass in the left lower lobe. There are multiple further pulmonary nodules.
In the dependent aspects of the left upper lobe is areas of interlobular septal thickening and dependent consolidation. Consolidation in peribronchovascular pattern in the right lower lobe with further mass lesions and regional architectural distortion with interlobular septal thickening.
Remainder of the lungs are emphysematous. Left-sided pleural thickening but no definite pleural effusion. Hilar and mediastinal enlarged lymph nodes.
Hepatosplenomegaly in keeping with history of myelodysplasia.
Mixed pattern of pulmonary disease with cryptogenic organising pneumonia (COP) to be considered most likely followed by chronic eosinophilic pneumonia. Infection is considered less likely.
The patient was admitted under the respiratory unit and was diagnosed with COP. He started steroid for treatment with mixed benefit.