Acute respiratory distress in a neutropenic febrile patient after hematopoietic cell transplantation

A 46-year-old male underwent hematopoietic cell transplantaion (HCT) (day 0) from a 9/10 matched unrelated bone marrow onor, for an acute myeloid leukemia (AML). The conditioning egimen consisted of a non-myeloablative chemotherapy with cloarabine at 40 mg/m2 (from day −6 to day −2), treosulfan at 14 g/m2 from day −6 to day −4), antithymocyte globulin at 2.5 mg/kg from day −4 to day −2) and rituximab at 200 mg/m2 on day 1. The immunosuppressive regimen included cyclosporine and ethotrexate (on day +1, +3, +6 post-transplantation, 15 mg/m2, 0 mg/m2, 10 mg/m2, respectively). Routine pre-transplantation serological analyses revealed CMV-seronegative donor to a CMV-seropositive recipient