Short-term corticosteroid therapy in aspiration pneumonitis complicated by acute respiratory distress syndrome: A case report

Rationale: Aspiration of gastric contents (Mendelson syndrome) can cause chemical pneumonitis and quickly progress to acute respiratory distress syndrome (ARDS). Evidence for corticosteroids in this setting is limited, and guidelines are unclear. We describe a postpartum case of aspiration pneumonitis evolving to ARDS that improved after a short course of methylprednisolone. Patient concerns: A 27-year-old woman developed severe dyspnea, chest tightness, and hypoxemia after a cesarean section performed under general anesthesia. Diagnoses: On arrival at Cho Ray Hospital, she was tachypneic with bilateral crackles and a PaO 2 /FiO 2 ratio of 78.4. Chest radiography showed diffuse bilateral infiltrates, and bronchoscopy revealed edematous, secretion-free airways, findings consistent with aspiration pneumonitis progressing to early ARDS. Interventions: The patient was intubated, treated with lung-protective mechanical ventilation, broad-spectrum antibiotics, supportive care, and intravenous methylprednisolone at 1 mg/kg/day for 2 days. Outcomes: Oxygenation indices rose rapidly after steroid initiation, allowing stepwise ventilator weaning. She was extubated on day 5 and discharged on day 10 without respiratory symptoms, and postpartum recovery was uneventful. Lessons: Mendelson syndrome can progress within hours to severe ARDS even in otherwise healthy postpartum patients. Early airway protection with lung-protective ventilation, consideration of early bronchoscopy when feasible, and stewardship-based empiric antibiotics with de-escalation are important. A carefully monitored, time-limited corticosteroid trial may be considered in selected cases of chemical aspiration-related moderate to severe ARDS, but treatment should be individualized with close reassessment.