A high positive end-expiratory pressure (PEEP) was set due to hypoxemia (up to 14 cmH 2 O), with a PO 2 /FiO 2 of 141. Thorax radiography showed bilateral diffuse infiltrates, and slight cardiomegaly. Inotropic support was needed (dopamine at 15 μg/kg/minute) and a perfusion with furosemide (0.5 mg/kg/hour) was started. Laboratory analysis showed abnormal values for haemoglobin (7.7 g/dL), platelets (29,000/mm 3 ) and coagulation times including hypofibrinogenemia (85 mg/dL). She received red blood cell concentrates, platelets and fresh frozen plasma. The same antibiotherapy was maintained and acute liver failure support treatment was started.