Remission of Adult Respiratory Distress Syndrome*

A 62-year-old woman was admitted to the hospital because of dyspnea on November 21, 1991. She was born in Osaka and had lived in Osaka all her life. She had no medical history and no blood transfusion before her admission. At the time of hospital admission, she had a body temperature of 37.5°C, BP of 122/72 mm Hg, heart rate of 96/mm, and respiratory rate of 30/mm. Fine crackles were audible in both lungs. Neither organomegaly nor neurologic abnor malities were found. Cyanosis was detected on her skin. Laboratory data on admission were as follows: WBC count elevated to 14.4 [email protected] with normal differentiation. Lactate dehy drogenase (LDH) was elevated to 1,107 lUlL and C-reactive protein (CRP) to 33.9 mg/dl. Other transaminase data were within normal levels. Arterial blood gas analysis revealed marked hypoxia (Po2, 44.7 mm Hg; Pco2, 32.9mm Hg; pH, 7.528; and base excess, 6.1). A chest radiograph showed diffuse reticulonodular shadows (Fig 1, left) and chest computed tomography demonstrated diffusely in creased concentrations with air bronchograms. Stains of sputum for tuberculosis, fungus, and Pneumocysfis carinji were negative and cytologic study showed no malignant cells. Because ARDS had progressed, the patient was put on mechanical ventilation. Although we did not perform a lung biopsy because of her poor condition and the cause of ARDS was unclear, fosir cycles of psilse therapy with methylprednisolone at a dose of 1 g/d for 3 days was effective for ARDS. Arterial blood gas values recovered to within normal ranges and her chest radiographic finding improved remarkably (Fig 1, right). She recovered from ARDS and was discharged from the hospital on January 21, 1992. Her dose of oral prednisolone was reduced to 20 mg. Five months after her initial hospital discharge, she complained of general malaise and of high fever and she was readmitted on June 16, 1992. She was drowsy. She had a body temperature of 38.4°C, BP of 150/94 mm Hg, and heart rate of 80/mm. There were