Case 83

 An eighty six-year-old female presented with her daughter for appetite loss and general fatigue, associated with slight fever, cough and sputum at night. She had diarrhea for a few days. Inspection and auscultation revealed edema at bilateral lower extremities and fine crackles at bilateral back, respectively. Further, palpation revealed mass-like lesion at left lower abdomen. Laboratory test revealed: creatinine 2.14 mg/dL, LDH 232 U/L (100-200), Interleukin 2 12300 U/mL (15-519), CRP 9.81 mg/dL, white blood cells 4940 /mm³ monocytes 18.6%, lymphocytes 14.8%, Na 129mEq/L, K 3.4 mEq/L, Cl 89 mEq/L. KL-6 327 U/mL (< 500). She agreed to receive chest CT for further investigation. Five days later, she received pelvic MRI to check pelvic mass and ten days later, she received whole body CT to check the size changes of the lesions.

What is your diagnosis based on clinical symptoms and images of chest CT ?

1. Metastatic tumors

2. Fungus ball

3. Pneumonia

4. Pulmonary lymphoma

5. Anti-RNA synthetase syndrome

answer

2017.12.6