• Cihan Papan, Frank Langer, Jörg T Bittenbring, Hans-Joachim Schäfers, Rainer M Bohle, Peter Fries, and Sören L Becker.
• Institute of Medical Microbiology and Hygiene, Saarland University, Homburg/Saar, Germany. Electronic address: cihan.papan@uks.eu.
• Chest. 2020 Sep 1; 158 (3): e123-e126.

Case PresentationA 71-year-old man was admitted to our hospital because of diffuse chest pain and a mass on routine chest radiography. He did not report cough, dyspnea, fever, night sweats, or weight loss. His medical history was remarkable for chronic lymphocytic leukemia diagnosed 13 years before presentation, and secondary myelodysplastic syndrome diagnosed 2 years before the onset of the current symptoms. As a curative approach, he had received a matched unrelated stem cell transplantation 16 months earlier, and he had been in complete remission since. He developed chronic graft-vs-host disease, presenting mainly as oral ulceration (grade 1, according to National Institute of Health consensus criteria), which had been treated with oral cyclosporine and extracorporeal photopheresis. The immunosuppression had been tapered 6 months before presentation. Routine medication included co-trimoxazole prophylaxis twice per week. He had no known allergies, and he denied recent travels and sick contacts.Copyright © 2020 American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.

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