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2. Corticosteroids
Although the diagnosis is not confirmed, the best working diagnosis is radiation pneumonitis with a possibility of nitrofurantoin lung. The treatment for both is removal of the stimulus with addition of corticosteroids (4). Nitrofurantoin was already stopped on 1/3/13. Bronchoalveolar lavage is reasonably good at excluding infection and carcinoma. Radiation pneumonitis would best fit the patient’s pneumonitis in the absence of infection and metastatic cancer. However, the patient refused corticosteroids but did consent to follow-up. She returned 18 days later on 1/25/13 complaining of increasing shortness of breath. A repeat chest x-ray was performed (Figure 3).
Figure 3. Repeat chest x-ray on 1/25/13 showing progression of bilateral consolidation.
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