Abstract Acute respiratory distress syndrome (ARDS) remains a high‑mortality condition despite major advances in ventilatory and supportive care. Because lung injury is driven by uncontrolled inflammation and disruption of the alveolar–capillary barrier, corticosteroids have long been considered a biologically plausible therapy. Over several decades, randomized trials have evaluated different corticosteroid types, doses, durations, and initiation timings in heterogeneous populations, including patients with primary ARDS and those with sepsis or pneumonia complicated by ARDS. The COVID‑19 pandemic provided a unique opportunity to study a more homogeneous cause of ARDS, generating additional evidence supporting corticosteroid efficacy in virus‑related respiratory failure. Despite these advances, clinical practice remains variable worldwide. Evolving definitions, diverse trial designs, and etiologic variability have led to uncertainty regarding indication, optimal dosing, drug selection, and treatment duration. The new global definition of ARDS now includes patients supported with noninvasive ventilation or high‑flow nasal oxygen, raising questions about how evidence derived from invasively ventilated populations applies to these groups. Parallel research identifying inflammatory subphenotypes with potentially divergent treatment responses further underscores the need for individualized, evidence‑based strategies. In this review, we examine conceptual, biological, and clinical considerations and synthesize the available evidence to inform decision‑making. We propose a pragmatic, context‑based framework to guide corticosteroid use in ARDS according to etiology and patient characteristics, emphasizing early initiation—ideally within 24–48 hours—and regimens equivalent to ≥80 mg/day of methylprednisolone or ≥400 mg/day of hydrocortisone for at least seven days, which have demonstrated efficacy with an acceptable safety profile. Research priorities include optimizing dose and duration, evaluating non‑ventilated and underrepresented subgroups, and clarifying phenotype‑specific effects and long‑term safety.
Objetivo. Presentar un caso de reagudización ocular grave de enfermedad de Behçet (EB) refractaria, manifestada como un exudado fibrinoso prepapilar, y destacar el papel del monitoreo multimodal y del escalamiento a terapia anti-TNF (adalimumab) en el rescate visual. Caso clínico. Mujer de 31 años con EB de dos años de evolución (uveítis bilateral, aftas orales y eritema nodoso recidivante; HLA-B27 negativo), refractaria a colchicina y azatioprina, con siete recaídas oculares en 24 meses. Consultó por descenso brusco de la agudeza visual (AV) en el ojo derecho (OD) hasta 1/10, con escotoma central y metamorfopsias. La biomicroscopía mostró Tyndall 3+ en OD y el fondo de ojo una masa blanquecina prepapilar densa con proyección vítrea que impedía visualizar la papila. La tomografía de coherencia óptica (OCT) evidenció una masa hiperreflectiva prepapilar, engrosamiento de la capa de fibras nerviosas (132 µm) y un edema macular quístico severo (431 µm) con desorganización de las capas internas de la retina (DRIL). El campo visual 24-2 reveló un escotoma central con sensibilidad foveal de 7 dB. La resonancia magnética descartó realces patológicos. Se realizaron pulsos de metilprednisolona (1 g/día IV, 3 días) y se inició adalimumab, con resolución del exudado fibrinoso y recuperación funcional. Conclusión. El exudado fibrinoso prepapilar constituye una “bandera roja” de alta actividad en la EB. El reconocimiento de la refractariedad y el escalamiento temprano a anti-TNF, guiados por OCT y campo visual, resultan determinantes para preservar la visión central en pacientes jóvenes.
Adrenocortical carcinoma (ACC) is a rare malignancy with poor prognosis and limited response to current therapies. The sarcomatoid subtype represents the rarest and most aggressive form of ACC, with very few cases reported in the literature. We present the case of a 62-year-old male with a history of an untreated left adrenal incidentaloma, who was diagnosed four years later with advanced-stage sarcomatoid ACC. Despite surgical and oncologic treatment, the disease progressed rapidly with systemic involvement and limited survival. The histopathological diagnosis is particularly challenging, as this subtype is characterized by the coexistence of epithelial and fusocelular/pleomorphic components with sarcomatoid differentiation, which may hinder its distinction from other primary or metastatic neoplasms. This case underscores the importance of appropriate initial evaluation of adrenal incidentalomas and highlights the highly malignant behavior of this rare variant, emphasizing the need for early diagnosis and timely intervention.
Pulmonary carcinoids (PC) show variable clinical behavior and an increasing incidence. A small proportion of PCs may be functioning. In Latin America, data on these lesions remain limited. Objective: to describe the clinical and pathological characteristics, treatment, and outcomes of patients with PC treated at a single center in Argentina, highlighting functioning tumors associated with ectopic Cushing syndrome (SCE). Materials and methods: a retrospective observational study was conducted including patients diagnosed with PC treated between 2001 and 2025 at Hospital Privado de Comunidad. Demographic variables, tumor characteristics, treatment, recurrence, and overall survival were analyzed. Results: twenty-three patients were included: 16 (70%) typical carcinoids, and 7 (30%) atypical carcinoids. Median age was 58 years, with a predominance of females (57%), and diagnosis was incidental in 39% of cases. Lymph node involvement at diagnosis was observed in 26% of PCs. All patients with tumor recurrence (14%) had positive lymph nodes at baseline. Five-year overall survival was 79.6%. Two patients (9%) presented ECS due to ACTH secretion and achieved resolution of hypercortisolism after surgery. Conclusions: this singlecenter series provides local evidence on the endocrine–oncologic characteristics of PCs in Argentina, showing their clinical heterogeneity and the occasional association with ECS.
