CLINICAL IMAGE Pulmonary aspergillosis mimicking cryptogenic organizing pneumonia 1 concurrently with intrathecal methotrexate. Fol‑ lowing the second cycle of R‑CHOP, the PET‑CT scan showed progressive disease. Second‑line sal‑ vage treatment with alternating R‑IVAC (ritux‑ imab, ifosfamide, cytarabine, and etoposide) and R‑CODOX‑M (rituximab, cyclophosphamide, vincristine, doxorubicin, and methotrexate) reg‑ imens was initiated. e patient received a total of 2 cycles of R‑IVAC and 1 cycle of R‑CODOX‑M, which were complicated by severe pancytopenia with prolonged agranulocytosis. Over the next weeks, he presented with several episodes of fever with chills, while laboratory tests showed a marked elevation of the inflammatory parame‑ ters. Despite the broad‑spectrum antibiotic ther‑ apy, his general condition deteriorated. C‑re‑ active protein values were persistently elevat‑ ed (up to 237 mg/l; reference range <10 mg/l); however, cultures and fungal antigen assays re‑ mained negative. A high‑resolution CT (HRCT) scan showed features suggestive of cryptogen‑ ic organizing pneumonia (COP): bilateral con‑ solidations with a central ground‑glass density (FIGURE 1A–1D). However, based on a positive re‑ sult of the serum galactomannan antigen test, the diagnosis of probable IA was established, prompting the treatment with voriconazole. Microscopic examination of the specimens ob‑ tained during bronchoscopy demonstrated As- pergillus spp. hyphae, thus confirming the IA di‑ agnosis (FIGURE 1E and 1F). Despite intensive an‑ tifungal treatment with amphotericin B lipid complex, the evolution was marked by the ap‑ pearance of pulmonary cavities and nodules on HRCT (FIGURE 1G and 1H). e patient’s clinical con‑ dition further deteriorated and 7 months after Invasive aspergillosis (IA) is an opportunis‑ tic mold infection defined as tissue invasion by the Aspergillus spp. hyphae. 1 IA is increasingly recognized in immunocompromised hosts, and it leads to substantial mortality in this patient population. 2 Major risk factors include treatment with intensive chemotherapy for hematologic ma‑ lignancy, prolonged neutropenia, and solid organ or hematopoietic cell transplantation. 1,3 A 69‑year‑old man was referred to the de‑ partment of hematology for the treatment of diffuse large B‑cell lymphoma (DLBCL). Sev‑ eral months before the admission, the patient had presented with severe abdominal pain, nau‑ sea, fatigue, and jaundice. Computed tomogra‑ phy (CT) revealed a retroperitoneal mass mea‑ suring 140 mm × 106 mm × 200 mm, with cen‑ tral necrosis. Histopathologic examination of the core biopsy specimen confirmed the diag‑ nosis of DLBCL, not otherwise specified, acti‑ vated B‑cell type. Positron emission tomogra‑ phy (PET)‑CT revealed extensive lymph node in‑ volvement accompanied with bilateral ground‑ ‑glass opacities in the lungs. e patient un‑ derwent bronchoscopy with bronchoalveolar lavage, which yielded positive culture for ESBL‑ ‑producing Klebsiella pneumoniae and herpes sim‑ plex virus type 1. Despite the absence of clinical signs of infection, systemic therapy was post‑ poned and anti‑infective treatment with me‑ ropenem and acyclovir was administered, re‑ sulting in the resolution of the sings of pneu‑ monia on imaging studies. Standard systemic chemoimmunotherapy with the R‑CHOP regi‑ men (rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone) was administered CLINICAL IMAGE Invasive aspergillosis mimicking cryptogenic organizing pneumonia in a patient with diffuse large B‑cell lymphoma Wiktoria Grycuk 1,2 , Krzysztof Jamroziak 2 , Piotr Korczyński 3 , Marta Hałaburda‑Rola 4 , Beata Gierej 5 , Joanna Drozd‑Sokołowska 2 1 Faculty of Medicine, Medical University of Warsaw, Warsaw, Poland 2 Department of Hematology, Transplantation and Internal Medicine, Medical University of Warsaw, Warsaw, Poland 3 Department of Internal Medicine, Pulmonary Diseases and Allergy, Medical University of Warsaw, Warsaw, Poland 4 Second Department of Radiology, Medical University of Warsaw, Warsaw, Poland 5 Department of Pathomorphology, Medical University of Warsaw, Warsaw, Poland Correspondence to: Joanna Drozd‑Sokołowska, MD, PhD, Department of Hematology, Transplantation and Internal Medicine, Medical University of Warsaw, ul. Banacha 1A, 02-097 Warszawa, Poland, phone: + 48 22 599 28 18, email: Joanna.drozd-sokolowska@wum.edu.pl Received: November 21, 2022. Revision accepted: December 19, 2022. Published online: December 22, 2022. Pol Arch Intern Med. 2023; 133 (3): 16391 doi:10.20452/pamw.16391 Copyright by the Author(s), 2023