case_images: PMC11772900_01
case_images: Chest computed tomography images. Computed tomography images showed bilateral diffuse ground-glass opacities and infiltrates upon admission (a). After 15 days, the ground-glass opacities and infiltrates showed improvement (b)
case_images: 40981_2025_765_Fig1_HTML.jpg
case_images: PMC11772900_01_40981_2025_765_Fig1_HTML.jpg
case_images: Fig1
case_images: Computed tomography revealed bilateral diffuse ground-glass opacities and infiltrations (Fig. 1).
case_images: Clinical course and arterial blood gas analysis on day 1 and day 2. After begging plasma exchange, lactic acidosis worsened. In addition, oxygenation was inadequate. After beginning iNO, lactic acidosis and oxygenation improved, and arterial blood pressure increased. ABP, arterial blood pressure; PAP, pulmonary artery pressure; PE, plasma exchange; iNO, inhaled nitric oxide; NAD, noradrenaline; DOB, dobutamine; FIO2, inspired oxygen fraction; pCO2, partial pressure of arterial carbon dioxide; pO2, partial pressure of arterial oxygen; HCO3-, bicarbonate ion; Lac, lactate; p/f, partial pressure of arterial oxygen/inspired oxygen fraction; HFNC, high-flow nasal cannula
case_images: 40981_2025_765_Fig2_HTML.jpg
case_images: PMC11772900_01_40981_2025_765_Fig2_HTML.jpg
case_images: Fig2
case_images: Shortly after starting PE, the patient developed hypotension with systemic blood pressure (SBP) dropping below 80 mmHg, accompanied by worsening lactic acidosis (Fig. 2). Central venous pressure decreased rapidly from 15 to 12 mmHg after starting iNO, though PAP remained elevated initially (Fig. 2).