A 44-year-old man with relapsed diffuse large B-cell lymphoma is referred to critical care for assessment on day five following CAR-T cell therapy.
He had initially remained well post-infusion, but over the past 48 hours has developed persistent pyrexia, increasing oxygen requirements, and new confusion.
On examination, he is febrile at 39.2°C, tachycardic at 120 bpm, and hypotensive with a blood pressure of 80/50 despite fluid resuscitation. Oxygen saturations are 91% on 15L O2 via a non-rebreathe mask, and he is intermittently disoriented.
Blood tests reveal normocytic anaemia, neutropenia, elevated C-reactive protein, a rising lactate, deranged liver function, and new acute kidney injury. A chest x-ray shows bilateral patchy infiltrates, and the ECG shows sinus tachycardia with multiple ectopic beats.
He has been started on broad-spectrum antibiotics but continues to deteriorate.
