Abstract
Sepsis and subsequent organ dysfunction are significant complications in patients with acute lymphoblastic leukemia (ALL). This case report details the successful use of combined inhaled and intravenous colistin in a 22-year-old male with high-risk ALL who developed tumor lysis syndrome, febrile neutropenia, respiratory failure, sepsis, septic shock, capillary leak, and prolonged mechanical ventilation requiring tracheostomy. Colistin inhalation was well-tolerated, delivered via a vibrating mesh nebulizer, and led to clinical improvement. This report contributes to the growing evidence supporting the role of inhaled colistin as an adjunct therapy in multidrug-resistant (MDR) infections and highlights its potential impact on antimicrobial stewardship in immunocompromised patients.