An Elderly Man with Immunosuppression, Shortness of Breath, and Eosinophilia

post splenectomy complained that he had had shortness of breath since receiving a diagnosis of chronic lymphocytic leukemia in 1998. He had documented eosinophilia since 1999 that was attributed to his leukemia. He presented with a 2week history of worsening shortness of breath, cough productive of brown sputum, intermittent fevers and chills, mild night sweats, and poor appetite. He denied having diarrhea, abdominal pain, or recent travel and has lived in eastern Tennessee his entire life. Medications he was receiving included weekly rituxan for chronic lymphocytic leukemia, which had been added recently to his treatment regimen, as well as long-term steroid therapy. Physical examination revealed an elderly man who was afebrile and tachpneic (24 breaths/min). Oral ex-