The patient's presenting symptoms are likely to be related to a concurrent exacerbation of an acuired viral illness confirmed with positive swabs for Influenza B and Human metapneumovirus. On the ward he was noted to be going into an acute hemolytic crisis as part of pre-existing cold agglutinin disease. He was admitted to ICU for urgent plasmapheresis and observation post-procedure.

Findings of this tracheobronchomegaly manifested as part of his 20 year history of sarcoidosis. Concerns about the inability to achieve invasive ventilation in the current ICU setting have been raised as endotracheal tube balloons would not be large enough to prevent sizable cuff leak.