Abstract
A 65-year-old man presented with an acute onset of fever (39·8°C), dizziness, and headache without evident predisposition. A CT scan showed left upper lobe pneumonia and he received imipenem–cilastatin (2 g every 8 h), but his symptoms did not improve. However, on day 3 of admission, he rapidly developed refractory hypoxaemia, respiratory failure, and septic shock. He then presented to the Department of Critical Care Medicine at Guangdong Provincial People's Hospital (Guangzhou, China). The severity of hypoxia and multiple organ dysfunction syndrome did not match the pulmonary imaging changes from day 4 to day 9 (figure).
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