PMC3420500_01
Chest X-ray on day 14 after chemotherapy (ANC was less than 100 cell/muL).
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His maximum temperature was 40.1 C, his total white blood cell count was less than 100 cells/muL, blood cultures were drawn, and a chest X-ray was done (Figure 1).
Chest X-ray day 18 after chemotherapy (ANC was 1100 cell/muL).
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Eighteen days after chemotherapy, the day of recovery of neutropenia, his CXR showed significant worsening with bilateral infiltrates (Figure 2), his fever trended up, and his mechanical ventilation settings (FiO2 and PEEP) increased, he developed acute respiratory distress syndrome (his PaO2/FiO2 was less than 200 with bilateral infiltrates on CXR).
Chest X-ray day 22 after chemotherapy (ANC was 11,500 cell/muL).
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Over the following three days, he continued to deteriorate clinically and CXR was getting worse (Figure 3) despite being on appropriate antibiotics and without an evidence of a new infection.
Chest X-ray day 31 after chemotherapy (ANC was 6700 cell/muL).
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After one week, we tapered his steroids down to prednisone 40 mg daily, antibiotics were continued for two weeks, patient was extubated successfully after 18 days of intubation, and CXR day 31 after chemotherapy is shown (Figure 4).