A two-year-old female child was hospitalized due to sustained fever and cough for 20 days. On examination, the patient had severe dyspnea.

Her chest X-ray showed bilateral infiltration; signs of a probable heart failure were absent. A tracheal intubation was facilitated, subsequently, her oxygenation index (OI) and PaO2/FiO2 (PF) ratio were 29 and 60 mmHg, respectively. A real-time polymerase chain reaction (rPCR) assay of tracheal lavage fluid was carried out. She was diagnosed with severe acute respiratory distress syndrome (ARDS) which developed from tuberculous (TB) pneumonia.

Anti-tuberculous therapy and cardiopulmonary support were commenced. Despite treatment with high-frequency oscillating ventilation (HFO), vasopressor support, and 1 g/kg of immunoglobulin her respiratory condition deteriorated. On day-3 of hospitalization, her International Society on Thrombosis and Hemostasis DIC score had increased to 5.

Recombinant human soluble thrombomodulin (rTM) was administered to treat the DIC. Thereafter, OI gradually decreased, after which the mechanical ventilation mode was changed from HFO to synchronized intermittent mandatory ventilation. The DIC score gradually decreased. Plasma levels of soluble receptor for advanced glycan end products (sRAGE) and high mobility group box 1 (HMGB-1), also reduced. Additionally, inflammatory biomarkers, including interferon-gamma (IFN-γ) and interleukin-6 (IL-6), decreased after the administration of rTM.