viernes, 26 de junio de 2015

A 40-Year-OldWoman From a Native Indian CommunityWith Non-Hodgkin Lymphoma and Hemoptysis - QUIZ

Figure 1. High-resolution computed tomography scan showing thinwalled
cavity in the left superior lobe with a focal consolidation.

Figure 2. Bronchoalveolar lavage fluid smear (original magnification,×40).

A 40-year-old woman from a native Indian community who lives in a rural area in Chocó, Colombia (a state on the northern Pacific coast of South America with an indigenous tropical rainforest) referred upon admission to our institution a positive epidemiological history of depending on handcrafted fishing for daily living. She presented to our institution with a 2-year history of a right submandibular tumor that had progressed over the past couple of months causing dysphagia with solid foods, limited mobility of the neck, and dyspnea. She subsequently complained of persistent cough with hemoptysis. 

Laboratory results were remarkable for anemia (8.3 g/dL) and eosinophilia (1.100 cells/μL). The patient had an excisional biopsy of the tumor on her neck and a tracheostomy because of airway compromise. The pathology report showed a diffuse large B-cell lymphoma. Systematic staging of the lymphoma included a computed tomographic scan of the thorax before the beginning of chemotherapy (Figure 1). A bronchoscopy was performed because of the hemoptysis, to rule out any infectious disease or neoplastic infiltration. The direct examination of the bronchoalveolar lavage fluid is shown in Figure 2.

What is your diagnosis?

Clinical Infectious Diseases 2013;57(5):711

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