Fig. 2

A representational case of patient who underwent TBLC. A 51-year-old female patient was admitted to the MICU with a chief complaint of shortness of breath for two weeks. The patient was diagnosed with immune-mediated necrotizing myopathy three months ago and was treated with oral corticosteroid and mycophenolate mofetil. Chest CT showed bilateral GGOs and consolidations after admission (a). Cytomegalovirus nucleic acid was detected in BALF in the initial assessment. However, after treatment of ganciclovir for over one week, the patient's shortness of breath deteriorated. Repeat chest CT still showed progressive pulmonary infiltrations (b). Then TBLC was performed under the recommendation in the first MDD (c). Pathology of TBLC revealed abundant abnormal lymphocytes infiltrating alveolar septal capillaries and interstitium (d). Immunohistochemistry revealed CD20(+) (e), CD34 (capillaries+) (f), CD3(−), CD79α(+), PAX-5(+). The diagnosis of intravascular large B-cell lymphoma was established according to pathology in the second MDD. Unfortunately, despite receiving life-saving chemotherapy, the patient died 14 days after MICU admission. CT: computed tomography; GGO: ground-glass opacities; BALF: bronchioalveolar lavage fluid; TBLC: transbronchial lung cryobiopsy; MDD: multidisciplinary discussion