1306 - Inpatient Rehabilitation of a Pediatric Patient Following Bilateral Lung Transplant for Acute Respiratory Distress Syndrome Secondary to Blastomycosis: A Case Report

Case Diagnosis: Bilateral Orthotopic Lung Transplant (BOLT) after Acute Respiratory Distress Syndrome (ARDS) Secondary to Disseminated Pulmonary Blastomycosis (DPB)

Case Description: A 16-year-old female with no past medical history presented to inpatient rehabilitation (IPR) after prolonged hospitalization for DPB infection leading to BOLT. Two months before admission to IPR, while in acute care, the patient was diagnosed with hypoxemic respiratory failure, which progressed to ARDS secondary to DPB with severe fibrosis. She required extracorporeal membrane oxygenation and ultimately BOLT. Her acute care course was complicated by septic shock, disseminated intravascular coagulation, subarachnoid hemorrhage, and hemoptysis. On admission to IPR, she was dependent for mobility and activities of daily living (ADLs) and initially reserved with poor participation. Multidisciplinary rapport building fostered trust while gradually improving engagement. Functionally, her rehabilitative course emphasized mobility and gait training while managing medical complexities, including respiratory insufficiency with airway clearance, active diuresis, anticoagulation titration, pain management, and psychiatric medication tapering. Twice, her IPR course was interrupted by respiratory complications necessitating transfer to acute care before home discharge.

Discussions: While pulmonary blastomycosis is common, progression to ARDS is a rare complication with significantly increased mortality rates. To our knowledge, this is the first documented pediatric case of a BOLT as a treatment for DPB and the first such patient in an IPR setting. Despite therapy disruptions, the patient progressed to supervision/touch assistance (A) for functional mobility, gait, and transitional movements, while requiring supervision/touchA with partial/moderateA for fine motor coordination. As of her one-year transplant follow-up, she is stable and has regained functional independence with ADLs and mobility.

Conclusions:

This case highlights the role of the physiatrist in managing complex and novel cases in an IPR setting and facilitating long-term patient success. Despite medical and psychosocial challenges, this patient continued to make meaningful functional gains throughout her IPR and outpatient rehabilitation course.