title: [Diagnostic difficulties caused by a pulmonary infiltrate].
abstract: Lung infiltration still causes differential diagnostic difficulties, which may delay the start of definitive treatment.
  
  
  METHODS
  The examination of a 30-year-old man began due intermittent, remittent and permanent fever. Chest X-ray confirmed infiltration in the right upper lobe, which was accompanied by elevated CRP and physiological levels of procalcitonin. Most likely atypical pneumonia, tuberculosis, Wegener's granulomatosis or a malignant process was suspected. Throughout his examination infection could not be verified, repeated CT guided transthoracic needle biopsy suggested the possibility of a malignant process. Through surgical exploration the intraoperative histology was not informative; thus, the pneumonitis-remodelled right lung was removed due to the possibility of malignant transformation. Histological examination revealed lymphocyte rich classical Hodgkin lymphoma, which was found to be stage IV/B based on the 18FDG-PET/CT scan; therefore, eight cycles of ABVD (adriablastin, bleomycin, vinblastine, and dacarbazine) therapy was administered successfully. The patient is currently (for 30 months) in a complete metabolic remission.
  
  
  CONCLUSIONS
  Primary pulmonary Hodgkin lymphoma is a rare disease entity (in this case it might be the original process), in which the diagnosis is often difficult. 18FDG-PET/CT may be a useful early diagnostic tool investigating fever of unknown origin.
authors: Debreceni Egyetem, Általános Orvostudományi Kar, Orvos- és Egészségtudományi Centrum, Debrecen Nagyerdei krt. 98. 4032. zsocogo@gmail.com
authors: Zsófia
authors: Z
authors: Simon
authors: Adám
authors: A
authors: Jóna
authors: Zsófia
authors: Z
authors: Miltényi
authors: Edit
authors: E
authors: Páyer
authors: Attila
authors: A
authors: Lieber
authors: Mária
authors: M
authors: Szilasi
authors: Arpád
authors: A
authors: Illés
mesh_terms: D000328:Adult; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage / Q000627:therapeutic use*; D014408:Biomarkers, Tumor / Q000097:blood*; D001706:Biopsy / Q000379:methods; D001761:Bleomycin / Q000008:administration & dosage; D003606:Dacarbazine / Q000008:administration & dosage; D003937:Diagnosis, Differential; D004317:Doxorubicin / Q000008:administration & dosage; D005335:Fever of Unknown Origin / Q000209:etiology*; D019788:Fluorodeoxyglucose F18; D006689:Hodgkin Disease / Q000097:blood / Q000150:complications / Q000175:diagnosis* / Q000188:drug therapy; D006801:Humans; D008168:Lung / Q000000981:diagnostic imaging / Q000473:pathology*; D008175:Lung Neoplasms / Q000097:blood / Q000150:complications / Q000175:diagnosis* / Q000188:drug therapy; D008297:Male; D064847:Multimodal Imaging / Q000379:methods; D049268:Positron-Emission Tomography; D012074:Remission Induction; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D014747:Vinblastine / Q000008:administration & dosage
chemical_list: D014408:Biomarkers, Tumor; D019788:Fluorodeoxyglucose F18; D001761:Bleomycin; D014747:Vinblastine; D003606:Dacarbazine; D004317:Doxorubicin