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Refractory ARDS with diffuse centrilobular nodules: did the patient smoke a tree?
  1. Thibaud Soumagne1,
  2. Estelle Dossot1,
  3. Hadrien Winiszewski1,
  4. Gael Piton1,2
  1. 1 Medical Intensive Care Unit, University Hospital of Besançon, Besançon, France
  2. 2 Research Unit EA 3920 and SFR FED 4234, University of Bourgogne - Franche-Comté, Besancon, France
  1. Correspondence to Dr Thibaud Soumagne, Medical Intensive Care Unit, University Hospital of Besançon, 25000 Besançon, France; thibaud_soumagne{at}

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A 22-year-old man with no relevant medical history except hashish use (10 joints a day) was admitted to the intensive care unit in December 2018 for refractory acute respiratory distress syndrome (ARDS). He presented dry cough and dyspnoea for 1 week. After intubation, veno-venous extracorporeal membrane oxygenation (VV-ECMO) was required because of severe hypoxemia and very low respiratory compliance (15 mL/cmH2O). Given the possibility of severe community-acquired pneumonia and influenza, urgent antibiotic therapy associating cephalosporin plus macrolid and …

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  • Contributors TS wrote the manuscript. TS, ED, HW and GP were in charge of the patient and have reviewed the manuscript and consistently improved its content.

  • 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 Obtained.

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