Her condition progressed rapidly to one of multiorgan failure requiring a high level of support on the ICU. Supportive strategies included mechanical ventilation for acute respiratory distress syndrome; circulatory support with inotropes/vasopressors and corticosteroids; and high volume haemofiltration for renal failure and severe metabolic acidosis. Corticosteroids were used empirically to treat probable underlying relative adrenal insufficiency. This occurs in up to 25% of critically ill patients with sepsis. Surviving Sepsis guidelines [9] published in 2004 do not suggest mandatory testing (by adrenocorticotrophic hormone: ACTH stimulation test) unless there is strong suspicion of undiagnosed primary adrenal insufficiency. The 10 mg/h infusion used in our patient was in line with the recommended 24 hour total dose of 200-300 mg. High volume haemofiltration was undertaken to target early shock reversal and removal of IL-6, increased expression of which is a hallmark feature of MCD. In animal studies, such a strategy is associated with improved haemodynamics and gas exchange, reduced immuno-paresis and increased survival [10] . The length of hospital stay post ICU discharge for our patient largely reflects the need for weaning from respiratory support and rehabilitation. Patients such as ours often experience profound muscle weakness (ICUacquired weakness) after mechanical ventilation on intensive care, and require intensive physiotherapy, as well as nutritional, psychological and social support.