Clinical History -- Hemoptysis and Fever

FURTHER HISTORY:

• The patient underwent matched unrelated bone marrow transplantation for CML eight months prior to admission. She had reported prior episodes of graft-versus-host disease (GVHD). Two days prior to admission, she developed a gradually worsening cough, associated with nausea. One day prior to admission , the cough became continuous, keeping her from sleeping. She likewise developed a frontal headache. On the morning of admission, she reported blood streaked sputum and a fever of approximately 100 degrees Fahrenheit.
• Current medications include FK-506, Prednisone, K-Dur, Provera, Magnesium, Prilosec, Diflucan, Amoxicillin and Epogen.
• The patient was admitted with possible pneumonia. Chest radiographs showed mild progression of consolidation. CT scan showed pansinusitis. She had progressive deterioration over several days, developing cardiogenic shock. Blood cultures were negative. Bronchial and tracheal brushings, and bronchioalveolar lavage specimens grew Escherichia coli and coagulase positive Staphylococcus. Hepatitis profiles and CMV antigens were negative.
• Four days following admission, liver enzymes and lactate dehydrogenase showed marked elevations (see lab data).

Laboratory Data