A 62-year-old man with a history of stage IB seminoma treated with chemotherapy (including bleomycin and etoposide) 3 months ago presents to clinic with progressive dyspnea on exertion and nonproductive cough for 6 weeks. He denies fever, night sweats, or recent travel. Vital signs are notable for respiratory rate 22/min and oxygen saturation 92% on room air. Physical examination reveals fine bilateral crackles at the lung bases. Pulmonary function testing shows: TLC 65% predicted, FVC 68% predicted, FEV1 78% predicted, with FEV1/FVC ratio of 83%. Chest X-ray demonstrates bilateral fine reticular opacities predominantly in the lower lobes. Which of the following is the most likely diagnosis?
- A)Acute interstitial pneumonia from opportunistic infection
- B)Chemotherapy-induced pulmonary fibrosisGABARITO
- C)Radiation pneumonitis
- D)Pulmonary edema from chemotherapy-related cardiomyopathy
- E)Recurrent/metastatic malignancy with lymphangitic carcinomatosis
Explicação
Bleomycin is a well-established chemotherapeutic agent with dose-dependent pulmonary toxicity causing pulmonary fibrosis. The clinical presentation (3 months post-chemotherapy, insidious progressive dyspnea, nonproductive cough), PFT pattern (restrictive with ... Ver explicação completa e trilha adaptativa →