查看文章

A 78-year-old Caucasian male with a past medical history of bladder cancer presented with fatigue, cough, night sweats and 12-pound weight loss for 3months. He underwent transurethral resection of bladder tumor 1year ago for non-invasive bladder cancer. He was treated with intravesical Bacillus of Calmette and Guerin (BCG) immunotherapy for bladder cancer recurrence, which was stopped 2months ago after four treatment cycles as he developed fatigue.

On examination, his blood pressure was 104/86mmHg; the temperature was 99.4 F, pulse 98 beats/min, respiratory rate 21breaths/min and oxygen saturation of 92% on 4 l Oxygen. White Blood Cell was 13400 cells/mm3, Hemoglobin 8.4 g/dl, CRP 102mg/l and ESR 40mm/h. A Computed Tomography of the chest revealed fine reticular-nodular abnormality bilaterally (Figure 2). He underwent a bronchoscopy, and a bone marrow biopsy, revealing multiple …