#00065059

A 59-year-old male with advanced lung adenocarcinoma, multiple metastases (including bone and liver), and prior third-line docetaxel chemotherapy, was admitted to the oncology department for planned radiation therapy. This patient showed no detectable mutations in the driver genes of lung cancer, including EGFR, KRAS, ALK, ROS1, BRAF, MET, HER2, RET, and NTRK. On the 7th day of hospitalization, the patient developed persistent fever (38.5-39.5°C) and chest computed tomography (CT) scans revealed new multifocal ill-defined opacities in both lungs, suggesting an infectious etiology. Laboratory tests showed elevated white blood cell count (18.59×109/L), decreased hemoglobin ( 65 g/L), low platelet count (27×109/L), elevated procalcitonin (3.390 ng/ml), C-reactive protein (257.58 mg/L), and interleukin-6 (281.80 pg/ml) levels. Sputum culture identified Escherichia coli, Saccharomyces cerevisiae, and Candida parapsilosis. Liver function tests showed elevated triglycerides (2.46 mmol/L), serum glutamic-oxaloacetic transaminase (40.6 U/L), total bilirubin (24.5 μmol/L), and decreased albumin levels (32.5 g/L). Anemia parameters indicated markedly elevated serum ferritin (>24784 ng/ml). The coagulation profile of the patient was as follows: PT (prothrombin time) 16.4s, APTT (activated partial thromboplastin time) 59.2s, FIB (fibrinogen) 6.82g/L, TT (thrombin time) 18.1s, D-Dimer >20 ug/ml, and AT-III (antithrombin III) 64%. The bone marrow examination revealed hypercellularity with increased myeloid to erythroid ratios of 2.2:1, and marked granulocytic proliferation with a left-shifted maturation. Metastatic tumor cells were seen throughout the smear, with haemophagocytosis .

The figure showed metastatic adenocarcinoma of lung in bone marrow. (Wright-Giemsa stain, x1000)