Case 197

 A seventy seven-year-old male presented in our hospital for feeling a chill and fever of 37.6 to 38.3℃ from last night. He felt appetite loss but looked relatively fine. He received gastrectomy approximately one year ago. Pathologic findings revealed Stage IV gastric cancer with direct invasion to mesocolon. One months later, chemotherapy using HERCEPTIN and XELOX was prescribed. The side effect of severe glossitis emerged. Chest CT showed metastatic lung tumor which increased as time progress. Then, chemotherapy using Opdivo was prescribed instead of HERCEPTIN and XELOX. Three times prescription of Opdivo with prednisolone was conducted, which induced shrinkage of metastatic lung tumor. Laboratory test revealed CRP 2.92mg/dL, white blood cells 7900/mm³, neutrophils 93.2%, lymphocyte 5.8%, monocyte 1.0%, procalcitonin 0.17ng/dL, β-D glucan 1470 pg/mL (< 20). He received chest CT (Figs 1 – 3).

What is your clinical diagnosis?

1.　Virus pneumonia

2.　Pneumocystis jirovecii pneumonia

3.　Mycoplasma pneumonia

4.　Drug induced pneumonia

5.　Pneumococcal pneumonia

answer

2020.7.8