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Sepsis & Septic Shock

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62-year-old male with history of IgM myeloma with significant extramedullary disease complicated by renal failure, previously on daratumumab and lenalitomide with progression, now status post hyperCVAD. Presented with respiratory distress, neutropenic sepsis, streptococcus agalactiea, oral thrush, and bilateral pulmonary infiltrates. Patient was initially placed on BiPAP but required to be intubated and placed on mechanical ventilation with protective lung strategy 🫁.

Chest x-ray is shown below:

Bronchoscopy was done and BAL was sent for PJP and other tests. There were multiple mucosal white spots scattered in trachea and throughout the bronchial tree bilaterally as shown in these images:

What do you think?


Thank @Everyone for participating, this is candida tracheobronchitis!

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