BACKGROUND
Drowning-associated acute respiratory distress syndrome (ARDS) is generally considered a reversible condition, with most patients requiring only short-term mechanical ventilation. However, prolonged respiratory failure and fibroproliferative changes have rarely been described. We report a case of severe, prolonged ARDS following drowning complicated by recurrent pneumothorax and late-phase lung injury.
CASE REPORT
A 15-year-old girl developed ARDS following a drowning accident. Oxygenation collapsed shortly (PaO2/FiO2 ratio of 54.4), necessitating advanced ventilation and prone positioning. The clinical course was complicated by mediastinal emphysema and recurrent bilateral pneumothorax, associated with highly organized and cystic changes, requiring multiple chest tube insertions until day 57. Intensive treatment, including steroid pulses and nitric oxide inhalation, gradually improved respiratory function, resulting in the successful discontinuation of mechanical ventilation on day 53. Chest computed tomography on day 81 demonstrated marked improvement and resolution of organizing changes, with only limited residual organization. The patient was discharged home on day 93.
CONCLUSIONS
This case highlights that drowning-associated ARDS can, in rare cases, follow a prolonged course with fibroproliferative changes and recurrent complications such as pneumothorax. Nevertheless, even prolonged and complicated respiratory failure following drowning-associated ARDS may still demonstrate partial reversibility over time, suggesting the importance of avoiding premature therapeutic nihilism in similar cases.

Keywords: Drowning; Fibrosis; Pneumothorax; Respiratory Distress Syndrome