Low-grade B cell lymphoma...

A man in his 80s with low-grade B cell lymphoma background, localised colorectal cancer in remission and hypertension was admitted for an Enterococcus UTI following instrumentation. However, he had no known drug allergies or previous exposure to antiarrhythmics. The examination was suggestive of infective endocarditis. A peripherally inserted central catheter was inserted. He underwent a bioprosthetic mitral valve replacement. He got a short episode of postoperative atrial fibrillation (AF) requiring 4.4 g of amiodarone orally over four days (6–10) before cessation.

On Day 32, he developed AF, dyspnoea and hypoxia. He was offered diuretics alongside AF treatment. CXR demonstrated increased right-sided opacification with a concurrent rise in inflammatory markers. However, numerous investigations were unremarkable for an aetiology. CT chest demonstrated patchy ground-glass airspace disease with subpleural consolidation, as shown in the figure.

He continued to deteriorate, resulting in mortality. The histopathology noted a spectrum of changes post-death, including active alveolar damage with hyaline membrane formation. A mild chronic interstitial inflammation and patchy alveolar fibrosis thickening and prominent interstitial fibrosis were also seen. Unfortunately, no organism was cultured or identified on either biopsy or pleural fluid aspirate.