Suspected Virus-Inducing Severe Acute Respiratory Distress Syndrome Treated by Multimodal Therapy Including Extracorporeal Membrane Oxygenation and Immune Modulation Therapy

Acute Respiratory Distress Syndrome: An Unexpected Outcome of Suspected Viral Gastroenteritis

Acute respiratory distress syndrome (ARDS) is a life-threatening manifestation of diffuse inflammation damaging the lung pleura. Risk factors for development are numerous with most cases arising in those already hospitalized for critical illness. We describe a unique case of a healthy 20-year-old female developing myocarditis and severe ARDS while hospitalized for septic shock after initially presenting with gastroenteritis from a suspected Coxsackie B infection in the setting of an overseas military deployment. After two transfers via land and air, she reached a facility that delivered definitive care and survived. This case highlights how a common disease can develop into something far more deadly and how early recognition of ARDS risk factors can improve clinical decision-making at the time of admission.

Successful Treatment of Elderly Male With COVID-19 Infection With Severe Acute Respiratory Distress Syndrome Using Multimodal Therapy, Including Immune Modulation Therapy

A 78-year-old man fell from a ladder and suffered a right distal tibial fracture. On the seventh day after injury, he developed a low-grade fever and was isolated in a private room. Polymerase chain reaction for COVID-19 was positive (day 4 from the day of saliva sampling). On day 5, he required 1 liter per minute of oxygen and dexamethasone therapy was initiated. On day 6, his D-dimer level was 25.0 μg/mL, and continuous infusion of heparin was initiated. From day 7, he was administered remdesivir. On day 9, his oxygenation suddenly showed a remarkable deterioration. He received a tentative diagnosis of COVID-19-induced pneumonia accompanied by severe acute respiratory distress syndrome (ARDS) and underwent urgent tracheal intubation and mechanical ventilation. He also received intravenous immunoglobulin (IVIG) and was also administered glycyrrhizin. His oxygenation gradually improved and extubation was performed on day 15. Following rehabilitation, he did not require oxygen on day 19. On day 20, his D-dimer level was found to be increased and enhanced computed tomography revealed pulmonary embolism. He was prescribed a direct oral anticoagulant. On day 28 he was transferred to a general ward for rehabilitation. These unspecific antiviral therapies and immune modulation therapy may be useful treatments for the main cause of ARDS, which may explain the favorable outcome that was obtained in the present case.