PMC9061985_01
(A) Chest X-ray revealing diffuse interstitial and airspace opacities. (B) Brain MRI revealing extensive fluid-attenuated inversion recovery (FLAIR) signal abnormalities throughout supratentorial parenchyma.
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Subsequently, she developed fevers, malaise, arthralgias, blurry vision, and abrupt acute hypoxic respiratory failure with intracranial hemorrhages requiring mechanical ventilation ( Figure 1 ).
Overview of treatment course. Platelet count (in K/microl, solid line) and CD20+ B-cell count (in cells/microl, dotted line) from beginning of presentation until hospital discharge is shown. Symptom onset is shown on top, while therapies are shown on bottom with corresponding arrows. This demonstrates rapid B-cell depletion following obinutuzumab therapy with gradual rise in platelet count.
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Given the severity of her bleeding, she was concurrently retreated with IVIG, continued on high-dose corticosteroids and romiplostim, and initiated on mycophenolate mofetil that was subsequently transitioned to sirolimus ( Figure 2 ).