Acute Respiratory Distress Syndrome Complicating Influenza-Associated Community-Acquired Pneumonia in a Patient with Rheumatoid Arthritis and Type 2 Diabetes Mellitus: A Case Report

Abstract

Objective: Acute Respiratory Distress Syndrome is a life threatening clinical syndrome characterized by diffuse inflammatory lung injury resulting in severe hypoxemia and respiratory failure. Community acquired pneumonia (CAP) is one of the common precipitating causes of ARDS. Early recognition and prompt multidisciplinary management are essential for improving patient outcomes.

Case Presentation: A 62-year old female with a history of rheumatoid arthritis and uncontrolled type 2 diabetes mellitus presented with shortness of breath for five days. On admission, she developed severe respiratory distress requiring non-invasive ventilation (NIV) and intensive care management. Laboratory investigations demonstrated leukocytosis, elevated inflammatory markers, raised brain natriuretic peptide (BNP), elevated inflammatory markers, raised rheumatoid markers, and electrolyte abnormalities. Computed tomography (CT) of the chest revealed bilateral diffuse ground-glass opacities with pleural effusion and features suggestive of pulmonary edema. The patient was treated with oxygen support, vasopressors, broad spectrum antimicrobial therapy, oseltamivir, corticosteroids, bronchodilators, diuretics, antiplatelet agents, anticoagulants, insulin therapy, and supportive care. Her clinical condition gradually improved, and she was discharged in a hemodynamically stable condition with appropriate medications and follow-up advice.

Conclusion: This case highlights the complexity of managing acute respiratory failure in a patient with multiple comorbidities. Early intensive care support, prompt antimicrobial therapy optimization of cardiovascular status, and multidisciplinary pharmaceutical care contributed to clinical improvement.