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Case report
Potential role for furosemide in the treatment of acute respiratory distress syndrome (ARDS) and an unusual presentation of pulmonary embolism in a complex patient
  1. Lior Zornitzki and
  2. Gil Bornstein
  1. Internal Medicine B, Tel Aviv Ichilov-Sourasky Medical Center, Tel Aviv, Israel
  1. Correspondence to Dr Lior Zornitzki; lior.zoz{at}


An 81-year-old woman was admitted to our hospital after experiencing syncope. She was diagnosed with a large pulmonary embolism and was hemodynamically unstable therefore requiring endotracheal intubation and norepinephrine support. She presented with an upper gastrointestinal bleed which prevented her from receiving tissue plasminogen activator. She was treated with enoxaparin and ceftriaxone. Her blood, sputum and urine cultures were negative. When transferred to our ward, her antibiotic treatment was changed to piperacillin–tazobactam. A lumbar puncture was not suggestive of a central nervous system infection. Chest X-rays demonstrated rapid advancement of diffuse bilateral infiltrates which were not present at first and were interpreted by radiology consultation as suggestive of acute respiratory distress syndrome. An echocardiography showed right ventricle dilatation without left-sided heart failure. Diuretics were added and with this treatment, a quick respiratory improvement was noted as she regained consciousness and extubated shortly after.

  • venous thromboembolism
  • respiratory system
  • pulmonary embolism
  • mechanical ventilation
  • cardiovascular system

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  • Contributors LZ identified the case. LZ obtained patient consent. LZ and GB were involved in the design of the case report. LZ conducted a literature review. LZ wrote the draft of the manuscript: GB revised the text for clinical relevance and accuracy. GB gave a final approval of the version to be published. LZ wrote the final version of the case report.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Parental/guardian consent obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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