Prolonged Methylprednisolone Therapy in the Fibro-Proliferative Phase of Acute Respiratory Distress Syndrome

Abstract

Late-stage acute respiratory distress syndrome (ARDS), primarily associated with fibro-proliferative changes, may occur in many patients. This stage, where ARDS progresses to the point of being incurable, involves a complicated and long clinical course that may give rise to functional loss; it has therefore been a major focus of both preventive and therapeutic strategies. In the present case report, the successful use of prolonged methylprednisolone therapy in the fibro-proliferative phase of ARDS is described in a patient who developed pneumonia and secondary ARDS after terminating a pregnancy due to preeclampsia. Methylprednisolone therapy, which was initiated at a daily dosage of 1 mg/kg, was tapered down based on the clinical and radiologic status of the patient and was terminated at the end of the sixth month. Follow-up imaging studies and pulmonary function tests performed at the end of the first and sixth months showed marked improvements and the patient experienced no systemic adverse effects despite long-term steroid therapy.

Keywords: acute respiratory distress syndrome; methylprednisolone; prolonged methylprednisolone therapy; pulmonary fibrosis; respiratory distress syndrome.

Figure 1. Thorax CT images of the patient before corticosteroid treatment showing bilateral extensive ground-glass opacities with adjacent traction bronchiectasis and interlobular septal thickenings.

Figure 2. Hematoxylin and eosin staining, 20X: (A) Fibroblastic proliferation marked with circle; (B) Type II pneumocyte hyperplasia and hypertrophy marked with arrows

Figure 3. Thorax CT images of the patient after corticosteroid treatment showing resolution of nearly all ground-glass opacities.