The patient responded after 24 hours; noradrenaline was tapered to 0.25 μg/kg/min and hydrocortisone (300 mg/ day) was added as adjunctive therapy. Additional antibiotics included piperacillin/tazobactam (18 g/day) and linezolide (1.2 g/day). Blood, urine and bronco-alveolar lavage (BAL) cultures were negative. Real-time PCR for influenza A/H1N1 virus (BAL specimen) was positive and oseltamivir was administered at 300 mg/day.