Patient F
This patient was a 8 week old ex-25 weeks preemie who was admitted for
E. coli sepsis, presumed fungal sepsis, respiratory failure and grade 4
Intraventricular Hemorrhage (IVH). He was noted to have diffuse anasarca
and bilateral pleural effusions, which were initially attributed to
ongoing infections. However, due to persistent anasarca and pleural
effusions even after finishing the course of antibiotics and antifungals
and repeated failed attempts to clamp the chest tube, vascular team was
consulted for concern for congenital lymphatic malformation. Since
initiation of sirolimus at a dose of 0.8 mg/m2/day PO, chest tube output
decreased ranging from 6-24 ml/day and team was able to pull out the
chest tube on day 14 (Fig 2). Sirolimus levels were therapeutic when
checked on day 16.