• Megumi Horiya, Takatoshi Anno, Ryo Shigemoto, Katsumasa Koyama, Fumiko Kawasaki, Koichi Tomoda, Kohei Kaku, and Hideaki Kaneto.
• Department of General Internal Medicine 1, Kawasaki Medical School, Okayama, Japan.
• Medicine (Baltimore). 2022 Mar 25; 101 (12): e29119e29119.

RationaleAcute respiratory distress syndrome (ARDS) is an acute diffuse inflammatory lung injury. Many causes of acute direct and indirect lung injury have been described as possible initiators of ARDS. According to the literature data, ARDS could be a rare complication associated with the acute onset of diabetic ketoacidosis (DKA). Moreover, it has been suggested that cytokine release during DKA is involved in the above-mentioned acute clinical complications of DKA.PatientconcernsA 48-year-old Japanese woman with a 4-year history of type 1 diabetes mellitus was brought to an emergency room with symptoms of deteriorated consciousness. Three days before, she was diagnosed with influenza A infection.DiagnosisInflammation markers were markedly elevated and she was under DKA condition. Since her respiratory conditions were suddenly and markedly aggravated 2 days later, we diagnosed her as ARDS and continued systemic management with the ventilator.Interleukin-6 (IL-6) level was markedly elevated at the onset of ARDS, although IL-6 level was high at the onset of DKA. ARDS was suggested to be caused by marked cytokine storm and DKA.InterventionsWe continued to treat her hyperglycemic crises. Moreover, we continued systemic management with the ventilator.OutcomesApproximately three weeks later, her general conditions were stabilized and ventilator management was stopped. We successfully treated her ARDS and hyperglycemic crises.LessonsThis case is very important because it shows that DKA can induce cytokine storm, which leads to the onset of ARDS. Therefore, monitoring various cytokines such as IL-6, which are associated with ARDS during the period of treatment of DKA is beneficial.Copyright © 2022 the Author(s). Published by Wolters Kluwer Health, Inc.

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