This patient is 20 years old at 29 weeks' gestation. She presented with pyelonephritis. She had been treated with intravenous ampicillin and gentamicin. The diagnosis is confirmed by E. coli cultured from the urine. She now presents with dyspnea and tachypnea. The most likely etiology for her respiratory symptoms is ARDS, with pulmonary injury due to endotoxin release. This typically occurs after antibiotics have begun to lyse the bacteria, leading to endotoxemia. The endotoxins can induce damage to the myocardium, liver, kidneys, and lungs. The mechanism is leaky capillaries, which allows fluid from the intravascular space to permeate into the alveolar areas. A chest film may show patchy infiltrates; however, the chest radiograph may be normal early in disease process. Treatment includes oxygen supplementation, careful monitoring of fluids (not to overload), and supportive measures. Occasionally, a patient requires intubation, but usually the condition stabilizes and improves.

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