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CT airspace infiltrates more marked in both lower lobes with a "crazy paving pattern". He was considered to have interstitial lung disease and steroids were initiated.

In May 2007 he represented with one week of fever, increased work of breathing and dry cough. He had respiratory difficulty with hypoxia. The Chest radiograph showed bilateral infiltrates and he was admitted to the PICU and treated with antibiotics and BiPAP. He was slow to improve with a persistent oxygen requirement. There was concern he had gasto-oesophageal reflux disease with aspiration pneumonitis. A repeat bronchoscopy showed semi-opaque milky aspirates. The pathology report was of a proteinaceous debris admixed with macrophages. Rare groups of likely reactive epithelial cells and cholesterol type clefts were also noted. It was Periodic Acid Schiff (PAS) positive debris with a few lipid laden macrophages.

This was his chest x-ray

Figure 2

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