Abstract
Acute respiratory distress syndrome (ARDS) has been intensively and continuously studied in various settings, however, mortality from this disease remains as high as 30–40%.
A 5X-year-old man presented to the ENT service with a 3-month history of discomfort in the pharynx. Based on the findings of endoscopy and positron emission tomography/computed tomography (PET/CT), the patient was diagnosed as having oropharyngeal carcinoma (T4aN2cM0). Two cycles of TPF chemotherapy (docetaxel, cisplatin and 5-fluorouracil) were administered, which led to no reduction of the tumor size. Therefore, radiotherapy was combined with administration of cetuximab (bioradiotherapy: BRT).
BRT was associated with an enhanced severity of mucositis, resulting in aspiration. The respiratory function deteriorated gradually, and eventually, the patient was diagnosed as having ARDS. Artificial non-invasive positive pressure ventilation (NPPV) was initiated, along with administration of neutrophil elastase inhibitor (sivelestat) and methylprednisolone (1 mg/kg). In response to the treatment, the respiratory function gradually improved and the patient could be weaned off NPPV on the 14th day.
