Inhalation therapy with nitric oxide has been suggested as beneficial in the adult respiratory distress syndrome, however there are few reports of its prolonged use. We report a patient with a chronic lymphocytic leukemia that developed an adult respiratory distress syndrome with severe hypoxemia, refractory to conventional therapeutic measures, during the course of a septic shock. The patient received nitric oxide (19 ppm) improving arterial oxygen saturation and allowing the reduction of FiO2 to 40%. The patient died five days later due to a multiple organ failure.