CASE REPORT: Pulmonary edema complicating ovarian hyperstimulation syndrome : Low-pressure edema, high-pressure edema, or mixed edema?

Ovarian hyperstimulation syndrome (OHSS), a serious iatrogenic complication of ovulation induction treatment, is associated with substantial morbidity and occasional mortality. OHSS is characterized by increased capillary leak with massive transudation of protein-rich fluid from the vascular space into the peritoneal, pericardial, and pleural cavities and alveoli. Serious respiratory manifestations complicate this disorder, including pulmonary edema, pulmonary embolism, and massive pleural effusion, which may necessitate admission to the intensive care unit (ICU). Pulmonary edema complicating OHSS has been reported as low-pressure edema, and OHSS patients with pulmonary edema requiring ICU admission have been diagnosed with acute respiratory distress syndrome (ARDS). We report a patient with severe OHSS complicated by acute respiratory failure, bilateral alveolar infiltrate, and a high pulmonary capillary wedge pressure (PCWP), with good response to diuresis and fluid restriction and good correlation between PCWP and PaO2/FiO2 (arterial oxygen pressure/fraction of inspired oxygen