Correct!
3. Repeat bronchoscopy
The repeat CT scan shows worsening of the consolidation in the left lung but now there is also some patchy areas of consolidation in the right lung. This is not the usual course or radiation pneumonitis. Since another diagnosis seems possible and the first transbronchial biopsy showed nonspecific changes, a repeat bronchoscopy is indicated. Another course of corticosteroids or cyclosporine might be the correct therapy but only if repeat bronchoscopy is consistent with radiation pneumonitis.
A repeat bronchoscopy with bronchoalveolar lavage and transbronchial biopsy was performed. Bronchoalveolar lavage showed 12% eosinophils. The biopsy showed subacute injury with organization and extravascular eosinophils suggestive of eosinophilic pneumonia (Figure 5).
Figure 5. Transbronchial biopsy showing subacute injury with extravasation of eosinophils (H & E staining).
A diagnosis of radiation-induced eosinophilic pneumonia was made.
What treatment should the patient receive at this time? (Click on the correct answer to proceed to the sixth and final page)