Riders on the Storm

This case involves a 52-year-old male, who underwent a deceased donor orthotopic liver transplant 7 months prior, presented with a 2-week history of persistent fever, anemia, thrombocytopenia, and mild elevation of liver enzymes. Upon hospital admission, the patient was febbrile, alert and oriented, hemodynamically stable. Laboratory exams revealed worsening leukopenia, anemia, thrombocytopenia, hyponatremia, and elevated ferritin. On hospital day 5, the general condition of the patient rapidly deteriorated with dyspnea, asthenia, and worsening fever and pancytopenia.Computed tomography revealed splenomegaly and minimal bilateral pleural effusion.