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.