PMC7838496_01
Timeline of Events for Case 1. HCT, hematopoietic cell transplant; ICU, intensive care unit; ECMO, extracorporeal membrane oxygenation; CD, cluster of differentiation; G-CSF, granulocyte-colony stimulating factor.
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F1
On HCT day 60 (Figure 1), she developed respiratory distress with bilateral pulmonary infiltrates on chest radiography.
Serial chest radiographs for Case 1 demonstrating the progression and subsequent improvement of diffuse bilateral interstitial and alveolar opacities. (A) Initial decline prompting transfer to the ICU, (B) Mild respiratory improvement, (C) Worsening ARDS leading to transfer for ECMO evaluation, (D) ECMO-Cannulation, (E) Pre-decannulation.
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F2
However, on HCT day 69, she developed new bilateral infiltrates on chest radiography requiring reintubation (Figure 2).
PMC7838496_02
Timeline of Events for Case 2. HCT, hematopoietic cell transplant; ICU, intensive care unit; ETT, endotracheal tube; BAL, bronchoalveolar lavage; ECMO, extracorporeal membrane oxygenation; CRRT, continuous renal replacement therapy; TA-TMA, transplant-associated thrombotic microangiopathy.
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F3
On HCT day 4 (Figure 3), he was transferred to the ICU with systemic inflammatory response and worsening respiratory distress and was found to have Lactobacillus rhamnosus sepsis and mastoiditis.
Serial chest radiographs for Case 2 demonstrating the progression and subsequent improvement of diffuse bilateral interstitial and alveolar opacities (A) Following intubation, (B) Prior to transfer for ECMO evaluation, (C) Following ECMO cannulation, (D) Prior to ECMO decannulation, (E) Post-transfer back to referring center.
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F4
Chest radiography showed increased pulmonary opacities (Figure 4).