Progressive Dyspnea and Hypoxemia With Diffuse Pulmonary Infiltrates in a Previously Healthy Woman

      Case Presentation

      A 50-year-old woman presented with 3 months of cough, dyspnea, and fatigue. She also reported new fevers, night sweats, and a rash on her face and torso. On presentation she was tachycardic and tachypneic, with oxygen saturation of 81% on 2 L/min of oxygen. She was in mild respiratory distress. Results of the physical examination were remarkable for tender left cervical and axillary adenopathy and bibasilar pulmonary crackles. She had an acneiform rash on her face, chest, and back, consisting of multiple nonblanching erythematous or violaceous macules and papules (Fig 1) and had conjunctival edema. Admission laboratory test results were significant for a WBC count of 56,000, of which 79.5% were lymphocytes. Hemoglobin and platelet levels were normal. She was admitted for further management.
      To read this article in full you will need to make a payment
      Subscribe to CHEST
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Dearden C.E.
        T-cell prolymphocytic leukemia.
        Med Oncol. 2006; 23: 17-22
        • Blanc K.
        • Lefebvre A.
        • Chapuis N.
        • et al.
        Acute respiratory failure in a patient presenting T-cell prolymphocytic leukemia: specific leukemic lung involvement?.
        J Clin Respir Dis Care. 2016; 2: 116
        • Nucci M.
        • Nouer S.A.
        • Anaissie E.
        Distinguishing the causes of pulmonary infiltrates in patients with acute leukemia.
        Clin Lymphoma Myeloma Leuk. 2015; 15: S98-S103
        • Tenholder M.F.
        • Hooper R.G.
        Pulmonary infiltrates in leukemia.
        Chest. 1980; 78: 468-473
        • Punatar A.D.
        • Kusne S.
        • Blair S.J.
        • Seville M.T.
        • Vikram H.R.
        Opportunistic infections in patients with pulmonary alveolar proteinosis.
        J Infect. 2012; 65: 173-179
        • Franquet T.
        • Gimenez A.
        • Caceres J.
        • Sabate J.M.
        • Nadal C.
        Imaging of pulmonary-cutaneous disorders: matching radiologic and dermatologic findings.
        Radiographics. 1996; 16: 855-869
        • Ventre M.O.
        • Bacelieri R.E.
        • Lazarchick J.
        • Pollack R.B.
        • Metcalf J.S.
        Cutaneous presentation of T-cell prolymphocytic leukemia.
        Cutis. 2013; 91: 87-91
        • Bodey G.P.
        • Powell R.D.
        • Hersh E.M.
        • Yeterian A.
        • Freireich E.J.
        Pulmonary complications of acute leukemia.
        Cancer. 1966; 16: 781-793
        • Demirkazik F.B.
        • Akin A.
        • Uzun O.
        • Akpinar M.G.
        • Ariyurek M.O.
        CT findings in immunocompromised patients with pulmonary infections.
        Diagn Interv Radiol. 2008; 14: 75-82
        • Okada F.
        • Ando Y.
        • Kondo Y.
        • Matsumoto S.
        • Maeda T.
        • Mori H.
        Thoracic CT findings of adult T-cell leukemia or lymphoma.
        Am J Roentgenol. 2004; 182: 761-767
        • Tanaka N.
        • Matsumoto T.
        • Miura G.
        • et al.
        CT findings of leukemic pulmonary infiltration with pathologic correlation.
        Eur Radiol. 2002; 12: 166-174
        • Jain P.
        • Sandur S.
        • Meli Y.
        • Arroliga A.C.
        • Stoller J.K.
        • Mehta A.C.
        Role of flexible bronchoscopy in immunocompromised patients with lung infiltrates.
        Chest. 2004; 125: 712-722
        • Mulabecirovic A.
        • Gaulhofer P.
        • Auner H.W.
        • et al.
        Pulmonary infiltrates in patients with haematologic malignancies: transbronchial lung biopsy increases the diagnostic yield with respect to neoplastic infiltrates and toxic pneumonitis.
        Ann Hematol. 2004; 83: 420-422
        • Chaulagain C.P.
        • Pilichowska M.
        • Brinckerhoff L.
        • Tabba M.
        • Erban J.K.
        Secondary pulmonary alveolar proteinosis in hematologic malignancies.
        Hematol Oncol Stem Cell Ther. 2014; 7: 127-153
        • Kovalski R.
        • Hansen-Flaschen J.
        • Lodato R.
        • Pietra G.
        Localized leukemic pulmonary infiltrates: diagnosis by bronchoscopy and resolution with therapy.
        Chest. 1990; 97: 674-678
        • Porcu P.
        • Cripe L.D.
        • Ng E.W.
        • et al.
        Hyperleukocytic leukemias and leukostasis: a review of pathophysiology, clinical presentation and management.
        Leuk Lymphoma. 2000; 39: 1-18