A 63-year-old Japanese woman with no medical history presented as an outside hospital transfer for further management of acute hypoxemic respiratory failure. Per her family, the patient had developed a rash and intermittent shortness of breath 2 months prior to hospital presentation. The rash was described as an erythematous maculopapular rash located on her proximal arms, chest, and upper eyelids. She saw her primary care physician, who prescribed a course of oral and topical corticosteroids. Despite these symptoms, the patient had an excellent functional status and exercised several times per week without muscle weakness. Two months following the initial presentation, the patient progressively became lethargic, prompting her son to bring her to the hospital for admission and evaluation. While in the hospital, the patient had progressive shortness of breath and developed worsening hypoxemic respiratory failure. Despite broad-spectrum antibiotics, her hypoxemia worsened, requiring intubation. She was subsequently started on 80 mg of IV methylprednisolone three times daily and transferred to our institution for further management. The patient arrived from the outside hospital receiving deep sedation and paralysis. Despite maximal ventilator settings, the patient remained hypoxemic and developed shock requiring multiple vasopressors.
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