A 44-year-old man who was simply feeling general fatigue was found in an unconscious state on the same day. He also showed hypotension and therefore underwent vasopressor and steroid administration. Due to issues of pneumonia, he received meropenem and azithromycin in addition to the infusion of -globulin and glycyrrhizin. The results of a COVID-19 test, tradition TAS-103 of sputum, and collagen disease test were all bad. The serum computer virus neutralization assay like a serological test for Coxsackievirus B4 showed a four-fold increase in titer. The multimodal therapy mentioned above resulted in the improvement of his general condition, including acute respiratory distress syndrome (ARDS). With this report, we discuss the benefits of ECMO and immune modulation therapy in the treatment of severe ARDS. strong class=”kwd-title” Keywords: extracorporeal membrane oxygenation, immune modulation therapy, acute respiratory distress syndrome Introduction Acute respiratory distress syndrome (ARDS) is definitely a common cause of respiratory failure in critically ill patients and is defined from the acute onset of non-cardiogenic pulmonary edema, hypoxemia, and the need for mechanical air flow [1-4]. The pathology of ARDS is definitely diffuse alveolar damage, such as the quick development of capillary congestion, atelectasis, intraalveolar hemorrhaging, and alveolar edema, adopted days later on by hyaline-membrane formation, epithelial-cell hyperplasia, and interstitial edema . ARDS happens most often in the establishing of pneumonia, sepsis, aspiration of gastric material, or severe stress and is present in roughly 10% of all individuals in intensive-care devices worldwide . Although much progress has been made in improving supportive care for ARDS, effective pharmacological treatments have not yet been recognized, and mortality remains high at 30%-40% in most studies . We statement a case of suspected virus-inducing severe ARDS treated by multimodal therapy including extracorporeal membrane oxygenation (ECMO) and immune modulation therapy that led to a favorable end result for the patient. Case demonstration A 44-year-old man thought generalized fatigue TAS-103 and took the day off from work. His son called him on the same day time, but he did not respond. When the child visited his house, he found the patient unconscious?and called an ambulance. He had no remarkable TAS-103 medical history. He was a by no means\smoker and drank 20 g of ethanol per day. He worked well as a pickup truck driver and lived with his only child after his divorce. His work zone was not located in any of the districts that were reported to have COVID-19 attacks. When the TAS-103 crisis medical technicians examined him, he previously a tonic convulsive position with serious hypoxia, and he was carried to our medical center under bag-valve-mask venting with high-concentration air. On entrance, his Glasgow Coma Range was E1V2M3. A physical evaluation revealed the next findings: blood circulation pressure of 174/130 mmHg; heartrate of 140 beats each and every minute; a respiratory price of 30 breaths each and every minute; SpO2 of?75% under room 15 L each and every minute of oxygen; and body’s temperature of 36.9 C. A venous path was guaranteed, accompanied by endotracheal intubation. An arterial gas evaluation revealed the next results: Prp2 pH: 7.092; PCO2:?54.2 mmHg; PO2:?54.5 mmHg; bottom unwanted -15.0 mmol/L; and lactate: 6 mmol/L. Electrocardiography uncovered sinus tachycardia. A upper body X-ray uncovered a bilateral ground-glass appearance (Amount ?(Figure11). Open up in another window Amount 1 Upper body X-ray on arrivalThe picture displays a bilateral ground-glass appearance (arrow) Cardiac echo demonstrated hyper-dynamic left-ventricular wall structure movement. Whole-body CT uncovered a bilateral ground-glass appearance in the ventral lung areas and bilateral loan consolidation in the dorsal lung areas (Amount ?(Figure22). Open up in another window Amount 2 CT on arrivalThe picture displays a bilateral ground-glass appearance in the ventral lung areas (arrow) and bilateral loan consolidation in the dorsal lung areas (asterisks) CT:?computed tomography The pancreas was regular. The main outcomes of the blood evaluation were the following: WBC count number: 23,400/L (neutrophil 87%, lymphocyte 6%, monocyte 6%); hemoglobin: 16.5 g/dL; platelet count number: 22.0104/L; total proteins: 7.0 g/dL; albumin: 4.3 g/dL; blood sugar: 177 mg/dL; HbA1C: 5.5%; total bilirubin: 1.5 mg/dL; aspartate aminotransferase: 322 IU/L; alanine aminotransferase: 79 IU/L; lactate dehydrogenase: 1,108 IU/L; bloodstream urea nitrogen: 7.4 mg/dL; creatinine: 0.51 mg/dL; amylase: 413.