case_images: PMC11772267_01
case_images: Contrast-enhanced CT of the neck, chest and abdomen. (A1, A2) Axillary lymph nodes before and after VCA treatment. (B1, B2) Soft tissue mass around the subxiphoid before and after VCA treatment. (C1, C2) Paravertebral soft tissue image before and after VCA treatment. (D1, D2) Soft tissue mass in the inguinal region before and after VCA treatment. (E1, E2) Pulmonary infection before and after antifungal therapy. (F, G) PET-CT revealed active 18F-FDG metabolism in the superficial fascia and xiphoid process of the right chest wall after VCA treatment.
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case_images: PMC11772267_01_fimmu-15-1475974-g001.jpg
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case_images: Contrast-enhanced computed tomography (CT) of the neck, chest, and abdomen ( Figures 1A1, B1, C1, D1 ) revealed the presence of enlarged lymph nodes in bilateral submandibular spaces, adjacent to the carotid sheath and within the posterior triangle of the neck, supraclavicular regions, and axilla. Moreover, patchy nodules with ground-glass opacities and diffused distribution were scattered in both lungs, the lower lobes of which showed subpleural consolidation in the posterior basal segment ( Figure 1E1 ). The enlarged lymph nodes and soft tissue masses disappeared in CT scans following the first VCA course, indicative of a CR ( Figures 1A2, B2, C2, D2 ). The pulmonary infection had resolved ( Figure 1E2 ). A positron emission tomography-computed tomography (PET-CT) performed on May 30, 2024, identified a soft tissue mass in the subcutaneous tissue and the tip of the sternum that exhibited increased 18F-FDG uptake ( Figures 1F, G ).
case_images: Hemoglobin, white blood cell and platelet counts. (A) First course, (B) second course. The red arrow indicates the infusion of one therapeutic dose of platelets.
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case_images: During the period of myelosuppression associated with VCA therapy, he suffered from grade II leukopenia and grade IV thrombocytopenia, for which platelet transfusion was performed ( Figure 2A ). The enlarged lymph nodes and soft tissue masses disappeared in CT scans following the first VCA course, indicative of a CR ( Figures 1A2, B2, C2, D2 ). The period of BM suppression lasted for approximately 10 days, without any transfusion ( Figure 2B ).
case_images: Timeline of the patient's treatment and bone marrow, CT or PET-CT assessment. BMS, bone marrow smear.
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case_images: The disease timeline and treatment course of this patient is shown in  Figure 3 .