case_images: PMC5298528_01
case_images: Chest X-ray: acute onset of diffuse bilateral alveolar and interstitial opacities.
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case_images: Admission chest radiography showed new diffuse bilateral patchy alveolar and interstitial opacities (Figure 1).
case_images: Chest computed tomography scan on admission demonstrating diffuse nodular opacities with spiculated peripheral ground opacities (arrows) and bilateral lower lobe consolidation (arrow heads).
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case_images: On hospital day 2, chest CT revealed bilateral patchy consolidation and multiple enlarged axillary and mediastinal lymph nodes (Figure 2).
case_images: (A) Surgical lung biopsy (hematoxylin and eosin, 40x magnification) demonstrating lung parenchyma with focal dense lymphoid infiltrates (black arrows). Inset (100x magnification) composed of medium-sized cells with irregular nuclear contours, variably condensed chromatin, inconspicuous nucleoli, and moderate amount of cytoplasm. (B) Surgical lung biopsy (CD3 immunohistochemistry, 40x magnification) demonstrating a neoplastic aggregate of CD3 (+) cells (black arrows). The lymphoma cells were also positive for CD4, CD5, and CD7 and negative for CD8, CD30, ALK-1, and EBER.
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case_images: Histopathology revealed peripheral T-cell lymphoma, not otherwise specified (PTCL-NOS; Figure 3A and B).
case_images: Chest computed tomography scan after therapy. Resolution of nodular infiltrates with residual traction bronchiectasis and fibrosis from known nonspecific interstitial pneumonitis.
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case_images: Chest CT revealed interval improvement in pulmonary infiltrates and patchy consolidation (Figure 4), and the patient was extubated on hospital day 13 and discharged home on hospital day 28 with 3 liters per minute oxygen.