case_images: PMC10859126_01
case_images: CT chest without contrast.. CT was reported as interval development of branching opacities (tree-in-bud) and pleural-based areas of consolidation in the right upper and lower lobe, suggestive of pneumonia superimposed on chronic interstitial changes (as signaled by the red arrow).. Additionally, these findings were also described: interval development of thickening of the minor fissure on the right. Diffuse bronchiectasis. Emphysema. Interval improvement of pleural-based opacity at the medial basal segment of the left lower lobe compared to previous imaging. Interval improvement of pleural-based opacity in the posterior basal segment of the right lower lobe compared to previous imaging.
case_images: cureus-0016-00000052169-i01.jpg
case_images: PMC10859126_01_cureus-0016-00000052169-i01.jpg
case_images: FIG1
case_images: The chest x-ray showed right lung opacities, which were interpreted as "most likely early multifocal pneumonia." CT chest without contrast reported "interval development of branching opacities (tree-in-bud) and pleural-based areas of consolidation in the right upper and lower lobe suggestive of pneumonia superimposed on chronic interstitial changes" (Figure 1).
case_images: EGD showing esophageal ulcers.. Image in the left (A) was taken at the first EGD at the level of the middle esophagus, where an esophageal ulcer can be appreciated, which was biopsied. Image in the right (B) was taken during the second EGD, which was done emergently due to gastrointestinal bleeding, but at the same time, it was done after completing fluconazole therapy. The patient was still complaining of severe dysphagia and odynophagia at the time of the second EGD. . EGD: esophagogastroduodenoscopy.
case_images: cureus-0016-00000052169-i02.jpg
case_images: PMC10859126_01_cureus-0016-00000052169-i02.jpg
case_images: FIG2
case_images: Since there was no improvement in her dysphagia after several days of empiric treatment, esophagogastroduodenoscopy (EGD) was performed, which showed esophageal ulcers and an ulcerated lesion, both biopsied (Figure 2).
case_images: Second EGD showing a duodenal bulb ulcer.. These are images taken from the second EGD after a concern for upper GI bleeding developed. Figures (A)-(C) are images taken from the duodenal bulb. (C) shows the duodenal bulb where a duodenal ulcer with a visible vessel (Forrest IIa) was found.. EGD: esophagogastroduodenoscopy.
case_images: cureus-0016-00000052169-i03.jpg
case_images: PMC10859126_01_cureus-0016-00000052169-i03.jpg
case_images: FIG3
case_images: EGD was repeated urgently, hemostatic spray was applied to esophageal ulcers and a duodenal ulcer Forrest IIa (Figure 3).
case_images: Chest x-ray taken in the ICU showing bilateral pulmonary edema.. Chest x-ray was taken in the intensive care unit and read as follows: a left IJ central line catheter is placed, terminating in the projection of mid-SVC (red arrow). Hyperinflated lungs are seen. Widespread patchy alveolar interstitial ground-glass opacities in both lung fields are seen (both white arrows). Likely small bilateral pleural effusion present (black arrows).. SVC: superior vena cava.
case_images: cureus-0016-00000052169-i04.jpg
case_images: PMC10859126_01_cureus-0016-00000052169-i04.jpg
case_images: FIG4
case_images: Chest x-ray then showed bilateral patchy opacities consistent with pulmonary edema (Figure 4), which could be attributed to the severe refeeding syndrome.