In the ICU, he was haemodynamically stable and blood tests revealed pancytopaenia (haemoglobin, 10 g/L; haematocrit, 29%; platelets 25 × 10 9 /L, leukocytes, 6.7 × 10 9 / L); hyperbilirubinaemia (8.3 g/dL); γ-glutamyltransferase, 146 U/L; alkaline phosphatase, 241 U/L; and prothrombin time, 76 seconds. Renal function tests were within normal limits. The C-reactive protein level was 16 mg/dL. Arterial blood gas measurement while breathing air revealed marked hypoxia (PaO2, 63 mm Hg), normocapnia (PaCO2, 32 mm Hg), low oxygen saturation (93.7%), and a blood pH of 7.49. A chest radiograph showed bilateral interstitial infiltrates and a computed tomography (CT) scan showed right midzone alveolar shadowing without parenchymal infiltrations ( Figures 1A  and 1B) .