Over the next month our patient continued to be dependent upon mechanical ventilation and developed acute respiratory distress syndrome (ARDS). Other complications included respiratory syncitial virus (RSV) infection and central line-related deep vein thrombosis requiring a six-week course of heparin sulfate. A brain MRI showed diffuse patchy white matter lesions most prominent in the right frontal lobe, suggestive of ischemia. Concern arose for adrenal insufficiency and she received several courses of stress dose corticosteroids with intermittent tapers. Intermittent episodes of fever and worsening cytopenias continued over the next month and HLH, possibly MAS, remained a consideration. For this reason an 18-day trial of anakinra was undertaken. However, fevers continued and abnormalities in liver enzymes along with hematologic abnormalities continued.