case_images: PMC11786497_01
case_images: Chest computed tomography scan findings demonstrating the progression of lung lesions over time. (A, B) Initial presentation on 16 October 2023, with multiple small nodular shadows in both lungs (red arrows). (C, D) Progression to multiple consolidations and nodular high-density shadows on 21 December 2023. (E, F) Partial resolution of consolidations and nodular shadows on 20 January 2024
case_images: 13256_2024_4973_Fig1_HTML.jpg
case_images: PMC11786497_01_13256_2024_4973_Fig1_HTML.jpg
case_images: Fig1
case_images: Initially asymptomatic, a routine chest computed tomography (CT) scan on 16 October 2023, revealed multiple small nodules in both lungs (Fig. 1A, B). A repeat chest CT scan performed on 21 December 2023, demonstrated progression of the lung lesions, with the appearance of multiple patchy and nodular high-density shadows, suggesting an infectious or inflammatory etiology (Fig. 1C, D). A follow-up chest CT on 20 January 2024, revealed partial resolution of the previously noted pulmonary opacities (Fig. 1E, F).The patient was discharged with a prescription for oral methylprednisolone (20 mg daily) and instructed to attend regular follow-up appointments at the outpatient clinic for monitoring and further management.
case_images: Hematoxylin and eosin staining of the lung biopsy demonstrate diffuse proliferation of large cells at lower power (10x, A). Immunohistochemistry staining (10x, B, C) of the lung biopsy shows positive for CD20 and Ki-67.Hematoxylin and eosin staining of the bone marrow demonstrate active hematopoiesis with an increased granulocyte ratio and decreased erythroid ratio (10X, D)
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case_images: PMC11786497_01_13256_2024_4973_Fig2_HTML.jpg
case_images: Fig2
case_images: Hematoxylin and eosin staining of the lung biopsy demonstrate diffuse proliferation of large cells at lower power (Fig. 2A). Epstein-Barr virus encoded RNA (EBER), cyclin D1, CD21, myeloid cell nuclear differentiation antigen (MNDA), CD3, and CD5, while exhibiting a high Ki-67 proliferation index (about 90%, Fig. 2B, C). Epithelial cells stained positive for cytokeratin AE1/AE3 (AE1/AE3). Bone marrow aspirate revealed active hematopoiesis with an increased granulocyte ratio and decreased erythroid ratio (Fig. 2D).
case_images: Flow cytometry of the bone marrow identified 0.32% CD5-/CD10- monoclonal lymphocytes
case_images: 13256_2024_4973_Fig3_HTML.jpg
case_images: PMC11786497_01_13256_2024_4973_Fig3_HTML.jpg
case_images: Fig3
case_images: Flow cytometry identified 0.32% CD5-/CD10- monoclonal lymphocytes (Fig. 3).