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To the Editor,
An 81-year-old woman was admitted to the intensive care unit for septic shock. Crystalloid resuscitation was initiated, followed by treatment with broad-spectrum antibiotics immediately after sputum and blood cultures. As the patient was hemodynamically unstable, she was intubated and put on mechanical ventilation. On the first day of admission, auscultation revealed faint coarse crackles in the right lung. Chest radiography showed bilateral pleural effusion. Blood test results revealed a white blood cell (WBC) count of 9.2x103/μL (neutro-phils, 96.2%) and marked elevation of C-reactive protein (CRP) levels at 26.3 mg/dL; other results, including urinary tests, were within normal ranges. The sputum Gram stain was negative. On the second day of admission,...