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Figures

Fig. 1

Upper: evolution of chest x-ray shows diffuse interstitial-alveolar infiltrates and nodular shadows in the lungs on ICU admission (A), an accentuation and dissemination of alveolointerstitial infiltrates and right and left lower lobes atelectasis on day 5 after ECMO initiation (B). Day 15 of ECMO showed a partial resolution of the findings (C) and near complete resolution of the pulmonary infiltrates at ICU discharge (D). The insert shows the cannulation setting (the “χ-configuration”). Lower: evolution of high-resolution (1.0-mm collimation) CT scans obtained at levels of the bronchus intermedius showing a predominant pattern of bilateral multifocal segmental and subsegmental micronodular ground-glass pulmonary infiltrates. Note the areas of lobar consolidation and interlobular septal thickening. E, Air bronchograms are seen within the consolidations. This pattern is nearly resolved after 20 days of ECMO (F) and completely resolved at ICU discharge (G). The intra-atria cannulae configuration, the “χ-configuration” [17] , is illustrated in panel C, insert.

We report our first experience of treating an immunocompetent adult patient with acute respiratory distress syndrome (ARDS) due to type 1 herpes simplex (HSV1) pneumonitis, using extracorporeal membrane oxygenation (ECMO). Similar cases reported in literature are reviewed as well. The therapeutic options for this particular complication are discussed. Pneumonia caused by HSV1 is a rare finding in immunocompetent individuals; it occurs more often in immunosuppressed and ventilated patients. It is a severe illness; therefore, early diagnosis and initiation of treatment are imperative.

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