Can a Blood-Cleansing combo tame deadly lung Flare-Ups?

Copied word for word from the study's registry entry, so the wording is the study team's rather than ours.

Inclusion Criteria: 1. Patient ≥ 18 years of age 2. Admitted to ICU in the last 72 h 3. Definite or probable IPF diagnosis defined on 2018 ATS/ERS/JRS/ALAT guidelines or a possible usual interstitial pneumonia pattern on HRCT without etiology. 4. Definite AE-IPF according to the 2018 revised criteria : 1. Previous or concurrent diagnosis of idiopathic pulmonary fibrosis (if the diagnosis of IPF is not previously established, this criterion can be met by the presence of radiologic and or histopathologic changes consistent with usual interstitial pneumonia (UIP) pattern on the current evaluation); 2. Acute worsening or development of dyspnea typically of less than one-month duration; 3. Computed tomography with new bilateral ground-glass opacity and/or consolidation superimposed on a background pattern consistent with a UIP pattern (if no previous computed tomography is available, the qualifier "new" can be dropped); 4. Deterioration not fully explained by cardiac failure or fluid overload. 5. PaO2/FiO2 ratio \< 200 measured on FiO2 1 Exclusion Criteria: 1. Known hypersensitivity intravenous immunoglobulins or rituximab 2. Severe heart failure 3. Active and uncontrolled bacterial fungal or parasitic infection ruled out by at least one of these two conditions 1. Procalcitonin value at inclusion \< 0.25 ng/mL OR 2. Adapted antimicrobial therapy for at least 48 hours at inclusion 4. Positive multiplex PCR for Influenzae A and B, or VRS 5. Deep Veinous Thrombosis or Pulmonary embolism in the last six months 6. Prior exposures to human-murine chimeric antibodies 7. Ongoing treatment with a cellular immunosuppressant (e.g., cyclophosphamide, methotrexate, mycophenolate, azathioprine, calcineurin inhibitors, etc.) 8. Subject treated with more than 2 boluses of methylprednisolone (total dose \> 500mg of methylprednisolone) or one dose \> 10mg/kg in the last 72 hours 9. Uncorrectable coagulopathies or thrombocytopenia \< 30000/mm3 10. Active cancer (other than basal cell carcinoma of the skin) 11. Other source of immunosuppression (i.e. HIV infection, solid organ transplant, lymphoma or leukemia) 12. Pregnancy 13. Patient listed for lung transplantation 14. Patient on ECMO 15. Patient with a do-not-intubate order at inclusion 16. Concurrent participation in other experimental trials 17. Not Affiliation to the French social security 18. Not Written informed consent from the patient or a legal representative if appropriate 19. Hypersensitivity to corticosteroids, cotrimoxazole / atovaquone 20. Patients with severe renal insufficiency (creatine clearance \<15ml / min)