23667              HAEMORRHAGIC BRONCHOPNEUMONIA

The patient was a 57 year old man who presented initially with a ten-month history of increasing lethargy, anorexia, weight loss and intermittent sweats, and a five-week history of progressive enlargement of lumps in the neck and right axilla.  Biopsy of a supraclavicular lymph node showed a mixed cellular type of Hodgkin’s disease.  Bilateral leg lymphangiograms showed abnormal inguinal, pelvic and para-aortic lymph nodes.  A liver scan showed gross hepatomegaly with irregular uptake throughout the liver.  A bone marrow biopsy was normal.  A diagnosis of stage IVa Hodgkin’s disease was made and treatment with the M.O.P.P. regime (nitrogen mustard, vincristine (oncovin), prednisolone and procarbazine) was begun.  His final admission was about eight months later with a seven-day history of lassitude, anorexia, dizziness and pyrexia.  Investigations showed bone marrow depression, attributable to the cytotoxic therapy.  He continued to deteriorate and died after a hospital stay of six weeks.

The specimen consists of a portion of the right lung, showing marked confluent patchy haemorrhagic consolidation throughout the lower lobe.  The process is present to a somewhat lesser extent in the middle and upper lobes.  There is no macroscopic evidence of lymphomatous involvement.  Histology shows focal areas of intra-alveolar haemorrhage with scanty cells and many clumps of darkly staining cocci.