Young adult male, recently immigrated from South east Asia. 8 month history of progressive shortness of breath, non productive cough. I saw him in ICU having spent about a week on the wards with a gradually increasing fio2 requirement, then complete failure. Cxr showed significant bilateral white out. Intubated, ventilated, diagnostic bronchoscopy. Came back for cmv + oral flora. No obvious cause for immunodeficiency. Placed on VV ECMO for continuing failure. Then VVV ecmo due to poor flow. Continuing to deteriorate, we were getting post-oxygenator po2 in the 300s and pao2 around 50. This had been about 3 weeks in the ICU, so 3 different intensiveness. Then a resident is pulling together a full history to give report with and finds a late addition to the c&s for the bronch samples positive for blastomycosis that had been missed for 2 weeks. Got him on the right anti-fungal, but his ards and sepsis were so profound at that point that he died a couple days later. Kindly share below in a comment your interesting/unsolved cases that you've worked on recently. Source
