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.
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.
Endothelial dysfunction events (EDE) and veno-occlusive disease (VOD) are clinically relevant early complications after hematopoietic stem cell transplantation (HSCT). Data in haploidentical HSCT (HaploSCT) using post-transplant cyclophosphamide (PTCy) are limited in Latin American settings. We conducted a retrospective multicenter study including 310 consecutive adult patients (≥18 years) undergoing unmanipulated HaploSCT with PTCy between 2015 and 2022 across 8 centers in Argentina. EDE was defined as a composite endpoint including VOD, transplant-associated microangiopathy (TMA), renal dysfunction, diffuse alveolar hemorrhage (DAH), and posterior reversible encephalopathy syndrome (PRES); acute GvHD (aGvHD) was analyzed separately (MAGIC criteria). VOD cases were re-adjudicated using EBMT criteria as the standard. Disease risk was categorized using the disease risk index (DRI). All patients received ursodeoxycholic acid prophylaxis and PTCy-based GvHD prophylaxis. Cumulative incidence functions were estimated with competing risks and compared with Gray's test; Fine-Gray models were used for multivariable analyses. Overall survival (OS) was analyzed by Kaplan-Meier and log-rank testing (2-sided P < .05). Median age was 42 years (range 18 to 77) and median follow-up was 37.7 months. Most patients received myeloablative conditioning (75.2%); conditioning backbone was busulfan-based in 54.0%, TBI-based in 34.6%, and melphalan/other in 11.4%. At 1 year, cumulative incidence of EDE (composite including VOD) was 5.5% (95% CI 3.0 to 8.0), with median time to first EDE 30.5 days (IQR 16.3 to 36.8). Among 18 EDE cases, phenotypes were VOD (n = 9; 50.0%), transplant-associated microangiopathy (TMA) (n = 5; 27.8%), renal dysfunction (n = 2; 11.1%), diffuse alveolar hemorrhage (DAH) (n = 1; 5.6%), and posterior reversible encephalopathy syndrome (PRES) (n = 1; 5.6%). Patients aged ≤25 years had higher EDE incidence than >25 years (11.5% [95% CI 3.9 to 19.0] versus 3.8% [95% CI 1.3 to 6.2]; Gray P = .021). In multivariable Fine-Gray regression, age ≤25 years was the only independent predictor of EDE (SHR 4.26; 95% CI 1.42 to 12.74; P = .01). By day 100, cumulative incidence of grade II to IV and grade III to IV aGvHD was 29.8% (95% CI 24.2 to 35.4) and 9.0% (95% CI 5.3 to 12.8), respectively; EDE was associated with higher aGvHD incidence (SHR 3.14; 95% CI 1.47 to 6.68; P = .003). Median time to VOD diagnosis was 25 days (range 8 to 57); 44.4% were classical (≤21 days) and 55.6% late-onset, with severe VOD comprising 55.6%. Three-month VOD incidence was higher in patients ≤25 years (8.6% [95% CI 2.0 to 15.3]) versus >25 years (1.2% [95% CI 0.0 to 2.7]; Gray P = .001). OS was worse in patients with EDE (log-rank P = .014): median OS 7.9 months (95% CI 2.3 to 15.5) versus 23.4 months (95% CI 16.3 to 29.6), and 2-year OS 25.0% (95% CI 6.7 to 49.1) versus 49.6% (95% CI 43.2 to 55.7). In this multicenter adult HaploSCT-PTCy cohort, EDE and VOD were infrequent but associated with substantially inferior OS. Age ≤25 years consistently identified a higher-risk subgroup for EDE and VOD, supporting intensified surveillance and early recognition strategies in this platform.
