A case of pneumonia presenting with the acute respiratory distress syndrome

Adult respiratory distress syndrome (ARDS) or high permeability pulmonary oedema (HPPE) is an uncommon presentation of a viral pneumonia and usually occurs in the setting of a fulminant or severe viral pneumonia. HPPE can be loosely defined as those forms of pulmonary oedema with normal cardiac function associated with the accumulation of protein-rich fluid in the interstitial or intraalveolar spaces. Through the years, a number of phrases have been used to describe this entity: white lung, shock lung, wet lung, adult hyaline membrane disease, ARDS and others. The aetiology is varied but the clinical, radiologic and pathologic pictures are similar. In fact the pathologic picture is so consistent from patient to patient regardless of aetiology that it has been suggested that the term HPPE be used in place of the other commonly used ones. A case of HPPE of possible viral aetiology who responded to prompt intervention with a successful outcome, is described here.