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.


Based on the clinical data and test results, what is the most likely diagnosis?

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