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Background
Reports of bronchiolitis obliterans organising pneumonia (BOOP) occurring in women after radiation therapy (RT) for breast cancer have shown that radiation to the lung can induce OP. This clinical condition is called BOOP syndrome. The literature has shown lymphocytosis to be a characteristic finding in the bronchoalveolar lavage fluid (BALF) of patients with BOOP syndrome. This report is of special interest because the patient presented with neutrophilia in BALF.
Case presentation
A 61-year-old female, a housewife who had never smoked, was admitted to our hospital because of fever and dry cough. She had received a right partial mastectomy for breast cancer 8 months before admission, followed by 50 gray of adjuvant tangential irradiation 2 months later. Anastrozole was commenced when the radiotherapy was administered. She developed fever and dry cough 1 month before admission, and a chest radiograph revealed an infiltrative shadow in the right upper zone. She received garenoxacin for 1 week at that point, but her symptoms and abnormal lung shadow remained unchanged. Her vital signs on admission were a temperature of 37.2°C, blood pressure of 123/86 mm Hg, pulse of 117 beats per min with regular rhythm and oxygen saturation of 97% on pulse oximetry (SpO2 ). Fine crackles in the upper right lung were detected on auscultation, and cardiac sound indicated a regular rhythm with no heart murmur.
Investigations
Elevated levels of C reactive protein (7.37 mg/dl) were noted in the laboratory data. Clear evidence of liver dysfunction was also found (aspartate aminotransferase, 45 U/l; alamine aminotransferase, 53 U/l; lactate dehydrogenase, 221 U/l; alkaline phosphatase, 1178 U/l), presumably in association with the garenoxacin therapy. Various autoantibodies were negative. KL-6 and surfactant protein-D, markers of interstitial lung disease, were within normal limits. Chest radiograph revealed an infiltrative shadow in the right upper...