Diagnosis: Malignant lymphoma, lung cancer - MG

A 60-year-old woman experienced pain in her left chest, cough, and general weakness in 1992. She presented to a physician who prescribed some specific and non-specific anti-rheumatic treatments. A chest x-ray taken on October 9, 1992 showed a shadow covering the lower two-thirds of the left lung ( Appendix MG1 ).

She was admitted on 17 October 1992 to Aydin State Hospital. On physical examination, there was dullness, and the breathing sound was noted to be low over the left lung. The patient had fever. Laboratory findings showed an inflammatory syndrome, with white blood cell count of 27x103/µL, erythrocyte count of 3.21x106/µL, hemoglobin content of 10 g/dL. Some of the differential count percentages were as follows: Segmented neutrophils: 85 %; Lymphocytes: 13 %; Eosinophils: 2%. 2,000cc of serofibrous fluid was removed by punctum, and the patient was treated with antibiotics. Pleural biopsy and histopathological examination of the specimen were performed, and the patient was diagnosed with malignant lymphoma ( Appendix MG2 ). The computed tomography (CT) scan, performed on 27 October 1992, demonstrated a tumoral mass of 30.7mm x 23.4mm in the left lung ( Appendix MG3 ). The patient was advised to refer to Tepecik Chest Diseases Hospital (TCDH) in Izmir for further examination.

The patient's husband, who was diagnosed with lung cancer three years ago and who was treated by Dr. Ozel, took his wife on 2 November 1992 to Dr. Ozel. Her general condition was very poor. She could only walk with the help of others. Auscultation revealed that basal two-thirds of the left lung did not participate in breathing, and that dullness was present. Dr. Ozel recommended the family to take the patient to TCDH; however, the patient and her husband insisted in trying N.O. treatment. A test dose of 0.3cc of N.O.I. caused the patient's body temperature to rise to 38.2o C. She was placed on a regimen of 0.3cc dose of N.O.I. to be given daily, six days per week. It was advised to adjust the dosage according to maximum fever.

The patient's medical condition ameliorated gradually. X-ray taken on November 30, 1992 demonstrated remarkable regression of the tumor ( Appendix MG4 ).

The patient presented to Dr. Ozel on 18 January 1993 with an x-ray taken on the same date ( Appendix MG5 ). There was no tumoral mass demonstrated, and the patient was living normal daily life with no complaints. There was no more increase in fever after N.O.I. injections, and the patient was placed on a maintenance regimen with 0.3cc dose of N.O.I. to be administered once every two days.

The patient came to Dr. Ozel for a follow-up on 20 May 1993. She had no complaints, and there was no change in the body temperature after N.O.I. injections. The patient was recommended to end the maintenance treatment.

A follow-up x-ray taken on 11 July 1994 revealed no pathological finding ( Appendix MG6 ).

Another follow-up radiograph was taken on 14 May 1998; it revealed clear lungs, no infiltrates, effusions, or mass lesions ( Appendix MG7 ). The patient was in remission.

She was last contacted in 2002, and she was in remission.