CHEST Guidelines-Α-57-Year-Old-Woman-With-ARDS,-Cachexia,-and

Α-57-Year-Old-Woman-With-ARDS,-Cachexia,-and

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A 57-year-old woman from Central Greece was admitted to the ICU with acute hypoxemic respiratory failure, diffuse bilateral alveolar infiltrates, and ARDS. With no relevant medical history other than being an ex-smoker, the patient had been experiencing fever, cough, weight loss, jaundice, and cachexia over the prior two months while caring for her mother on a goat farm. Initial tests revealed high white blood cell counts, C-reactive protein, and ferritin levels, suggesting an acute inflammatory response. Imaging showed bilateral lung infiltrates, and she was treated for severe community-acquired pneumonia. <br /><br />Despite antibiotic treatment, her condition worsened, requiring mechanical ventilation. Further diagnostic testing aimed at identifying systemic infections or diseases was conducted. Bone marrow testing suggested no malignancies or microorganisms, but positive PCR results from bone marrow for Leishmania indicated visceral leishmaniasis (VL). Additionally, her serological tests identified antibodies for Coxiella burnetii, the bacterium causing Q fever.<br /><br />The clinical diagnosis concluded that ARDS resulted from secondary organizing pneumonia due to atypical pneumonia caused by C. burnetii, which co-occurred with VL. Her quick improvement with corticosteroid therapy confirmed organizing pneumonia. The patient underwent treatment for both Q fever (doxycycline) and VL (liposomal amphotericin B). After six months, she showed no signs of disease relapse or chronic infection.<br /><br />This case underscores the significance of considering zoonoses in patients with ARDS, particularly those with rural or animal contact backgrounds. It highlights the diagnostic challenges and the potential for co-infections, stressing the importance of comprehensive investigations in similar clinical presentations. The rapid response to steroid treatment in organizing pneumonia related to Q fever also emphasizes the need for both antibiotics and corticosteroids in treatment protocols.

Keywords

ARDS

visceral leishmaniasis

Q fever

Coxiella burnetii

zoonoses

organizing pneumonia

corticosteroid therapy

community-acquired pneumonia

mechanical ventilation

rural exposure