Dyspnea, nonproductive cough, and blasts on the peripheral smear.

A 33-year-old, previously healthy woman was re^^ferred to our hospital with a 3-week history of progressive shortness of breath and a nonproductive cough. Physical examination on admission revealed a well nourished, tachypneic white woman with a temperature of 37.6°C, blood pressure 121/73 mm Hg, and pulse rate of 96. Shotty right axillary aden¬ opathy and decreased breath sounds at the lung bases were noted. The remainder of the physical exami¬ nation was unremarkable. Laboratory findings were notable for a WBC count of 73,500 mm3, hemoglobin 8.5 g/dL, and platelet count of 66,000 mm3. The peripheral smear showed leukocytosis with blasts, atypical eosinophilic myelocytes, and thrombocytopenia. Electrolytes and coagulation parameters were normal. Arterial blood gas on 3 L oxygen revealed a pH of 7.39, Pco£ 46, P02 85, and SaC>2 96%. Bone marrow biopsy was diag¬ nostic for acute myelogenous leukemia. Chest radiograph showed bilateral airspace disease greatest in the midand lower-lung zones (Fig 1). High-resolution CT scan was performed. A repre¬ sentative image at the level of the right middle lobe bronchus revealed bilateral poorly defined air space radiopacities with sparing of the subpleural lung (Fig 2). Bronchoscopy with bronchoalveolar lavage was performed. Figure 1