What is your approach to the management of a patient with idiopathic pneumonia syndrome following stem cell transplant who does not demonstrate clinical improvement with steroid therapy?

Continue with good supportive care including diuresis, lung protective ventilation strategies for intubated patients, and a thorough evaluation for infection as retrospective studies have shown a relatively high rate of infection even in cases where the infection was considered to be ruled out (Seo et al., PMID 25918347). Bronchoscopy is indicated as part of this evaluation, with biopsy in some cases depending on imaging and risks. If a thorough infectious workup is negative, then I consider a T...