Case 257 Medical History A 17-year-old female patient with systemic lupus erythematosus undergoing chemotherapy for macrophage activation syndrome. Neutropenic since 4 weeks ago, neutrophils = 0-50 / uL, maintaining fever despite broad spectrum antibiotic therapy (antibacterials + antifungals), with no associated symptoms. She presented a positive serum test of galactomannan. Two computed tomography (CT) scans of the thorax were performed at intervals of one month between them, which are shown below. Image 1: Computed tomography (CT) of the thorax, axial section, supracarinal level, without intravenous contrast medium.Image 2: Computed tomography (CT) of the thorax, axial section, subcarinal level, without intravenous contrast medium, performed one month after the image 1 was obtained.Image 3: Computed tomography (CT) of the thorax, axial section, supracarinal level, without intravenous contrast medium, performed one month after the image 1 was obtained. Question:Based on the clinical data and test results, what is the most likely diagnosis? Pulmonary adenocarcinoma Allergic bronchopulmonary aspergillosis Eosinophilic pneumonia Invasive pulmonary aspergillosis Time is Up! Time's up
