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Page 2 / Case 10.03

OUR APPROACH WAS AS FOLLOWS:

The next day she had a pulmonary consultation. It was decided for her to have a bronchoscopy and BAL.

The results were as follows: Her airway was erythematous with increased secretions. Microscopy, Gram stain and cultures all were negative (including pneumocystis stains and fungal culture). Azithromycin and acyclovir were added to her treatments.

She was admitted to the ICU for cardiorespiratory monitoring because of hypokalemia and mild respiratory distress required oxygen supplement only. A repeat chest x-ray 2 days later is seen below.

ENLARGE this Xray.

DESCRIBE THE X-RAY.

WHAT IS YOUR DIFFERENTIAL DIAGNOSIS?

HOW WOULD YOU PROCEED IN THE MANAGEMENT?



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