A 24-year-old Asian woman at 32 weeks' gestation presented with a 2-day history of worsening dyspnea. She gave a history of sore throat, dry cough, fever, nausea, vomiting, myalgia, weakness and headache. Her examination revealed reduced air entry on both lower zones of the lung with crepitation on auscultation. The rest of the examination was unremarkable. Arterial blood gases (ABG) showed severe hypoxemia with po2 only 90 mmHg despite delivery of fio2 70% via NIV. She had an elevated C-reactive protein (CRP) 200 mg/L on admission. Her chest radiograph demonstrated bilateral opacities consistent with severe pneumonia (Fig. 2) in comparison with her normal chest radiograph taken 2 years prior to illness (Fig. 1). Her tracheal aspirate and urine culture were negative. There were also negative results for nasopharyngeal swab for H1N1. She also tested negative for dengue, infectious diseases such as tuberculosis, human immunodeficiency virus (HIV), hepatitis and syphilis. She was admitted to our ICU and was started on non-invasive ventilation (NIV) bi-level mode. Her condition gradually worsened within a day of admission. She was given intravenous rehydration and broad spectrum antibiotics, tazocin 4.5 g every 6 hours and levofloxacin 750 mg once daily and antiviral osetalmivir. She was planned for intubation if her dyspnea worsened, her respiratory rate increased to more than 35 breaths per minute, or there was a drop in consciousness level. The patient was started on a BiPAP, bi-level positive airway pressure (Philips-Respironics) after poor oxygenation with a high flow mask 15 liters oxygen. She was successfully weaned from NIV on day 3 of ventilation. She was discharged from the ICU to the general ward on day 5 and discharged home on day 13 of admission in good condition.
Fig. 2 (a). Patchy air space opacification of the bilateral mid and lower zone with the presence of air bronchogram consistent with consolidation with associated bilateral pleural effusion on the day of admission to the ICU. Fig. (2b) shows worsening of the bronchogram on Day 2. Fig. (2c) shows resolving consolidation and pleural effusion on Day 4.