The Myelodysplastic Syndrome and Bronchiolitis Obliterans

Excerpt

To the Editor: We have identified bronchiolitis obliterans with organizing pneumonia as a cause of refractory hypoxemia, infiltrates, and relentless fever in a patient with the myelodysplastic syndrome. A 58-year-old white man with a 40-pack-year smoking history presented with a 6-week history of fever, productive cough, dyspnea, and a weight loss of 4 kg. He also had pancytopenia. The total leukocyte count was 2700/mm3; the hemoglobin, 10.0 g/dL; and the platelet count, 73 x 10³/ mm³. A bone marrow biopsy specimen showed refractory anemia with excess blasts—a myelodysplastic syndrome. Physical examination showed the following: blood pressure, 125/65 mm Hg; pulse