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Respiratory syncytial virus pneumonia treated with lower-dose palivizumab in a heart transplant recipient.

Grodin JL, Wu KS, Kitchell EE, Le J, Mishkin JD, Drazner MH, Markham DW - Case Rep Cardiol (2011)

Bottom Line: Respiratory syncytial virus (RSV) is an important community-acquired pathogen that can cause significant morbidity and mortality in patients who have compromised pulmonary function, are elderly, or are immunosuppressed.The patient received aerosolized ribavirin, one dose of intravenous immunoglobulin, and one dose of palivizumab.After two months of followup, the patient had improved infiltrates on chest CT, improved pulmonary function testing, and no evidence of graft rejection or dysfunction.

View Article: PubMed Central - PubMed

Affiliation: Department of Internal Medicine, UT Southwestern Medical Center, Dallas, TX 75390, USA.

ABSTRACT
Respiratory syncytial virus (RSV) is an important community-acquired pathogen that can cause significant morbidity and mortality in patients who have compromised pulmonary function, are elderly, or are immunosuppressed. This paper describes a 70-year-old man with a remote history of heart transplantation who presented with signs and symptoms of pneumonia. Chest computed tomography (CT) imaging demonstrated new patchy ground glass infiltrates throughout the upper and lower lobes of the left lung, and the RSV direct fluorescence antibody (DFA) was positive. The patient received aerosolized ribavirin, one dose of intravenous immunoglobulin, and one dose of palivizumab. After two months of followup, the patient had improved infiltrates on chest CT, improved pulmonary function testing, and no evidence of graft rejection or dysfunction. There are few data on RSV infections in heart transplant patients, but this case highlights the importance of considering this potentially serious infection and introduces a novel method of treatment.

No MeSH data available.


Related in: MedlinePlus

Chest computed tomogram with intravenous contrast two months prior to admission revealing atelectasis of the left lower lobe (arrow).
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fig1: Chest computed tomogram with intravenous contrast two months prior to admission revealing atelectasis of the left lower lobe (arrow).

Mentions: A 70-year-old Caucasian man with a history of orthotopic heart transplantation (OHT) in 1999 for an ischemic cardiomyopathy presented with a five-day history of rhinorrhea, mylagias, and subjective fevers. In addition, he noted worsening orthopnea and an inability to lay flat without using a continuous positive airway pressure device. Subsequently he developed dyspnea with a productive cough of gray/white sputum. A routine posttransplant computed tomogram (CT) scan of the chest six months prior to admission revealed extensive atelectasis in the basal segments of the left lower lobe and lingula. A repeat CT scan two months prior to admission revealed worsening atelectasis of the left lower lobe (Figure 1). He therefore underwent a transbronchial biopsy of his left lower lobe. The pathology was unremarkable. Bronchial fluid cultures grew normal respiratory flora and cytology was negative for malignancy. Pulmonary function tests (PFTs) at that time were consistent with a restrictive physiology (Table 1). On the day of admission, the patient presented with symptoms suggestive of an acute infectious upper and lower respiratory process and worsening orthopnea from baseline. The chest radiograph (not shown) and CT of his chest at this time revealed new patchy ground glass infiltrates throughout the upper and lower lobes of the left lung (Figure 2).


Respiratory syncytial virus pneumonia treated with lower-dose palivizumab in a heart transplant recipient.

Grodin JL, Wu KS, Kitchell EE, Le J, Mishkin JD, Drazner MH, Markham DW - Case Rep Cardiol (2011)

Chest computed tomogram with intravenous contrast two months prior to admission revealing atelectasis of the left lower lobe (arrow).
© Copyright Policy - open-access
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC4008357&req=5

fig1: Chest computed tomogram with intravenous contrast two months prior to admission revealing atelectasis of the left lower lobe (arrow).
Mentions: A 70-year-old Caucasian man with a history of orthotopic heart transplantation (OHT) in 1999 for an ischemic cardiomyopathy presented with a five-day history of rhinorrhea, mylagias, and subjective fevers. In addition, he noted worsening orthopnea and an inability to lay flat without using a continuous positive airway pressure device. Subsequently he developed dyspnea with a productive cough of gray/white sputum. A routine posttransplant computed tomogram (CT) scan of the chest six months prior to admission revealed extensive atelectasis in the basal segments of the left lower lobe and lingula. A repeat CT scan two months prior to admission revealed worsening atelectasis of the left lower lobe (Figure 1). He therefore underwent a transbronchial biopsy of his left lower lobe. The pathology was unremarkable. Bronchial fluid cultures grew normal respiratory flora and cytology was negative for malignancy. Pulmonary function tests (PFTs) at that time were consistent with a restrictive physiology (Table 1). On the day of admission, the patient presented with symptoms suggestive of an acute infectious upper and lower respiratory process and worsening orthopnea from baseline. The chest radiograph (not shown) and CT of his chest at this time revealed new patchy ground glass infiltrates throughout the upper and lower lobes of the left lung (Figure 2).

Bottom Line: Respiratory syncytial virus (RSV) is an important community-acquired pathogen that can cause significant morbidity and mortality in patients who have compromised pulmonary function, are elderly, or are immunosuppressed.The patient received aerosolized ribavirin, one dose of intravenous immunoglobulin, and one dose of palivizumab.After two months of followup, the patient had improved infiltrates on chest CT, improved pulmonary function testing, and no evidence of graft rejection or dysfunction.

View Article: PubMed Central - PubMed

Affiliation: Department of Internal Medicine, UT Southwestern Medical Center, Dallas, TX 75390, USA.

ABSTRACT
Respiratory syncytial virus (RSV) is an important community-acquired pathogen that can cause significant morbidity and mortality in patients who have compromised pulmonary function, are elderly, or are immunosuppressed. This paper describes a 70-year-old man with a remote history of heart transplantation who presented with signs and symptoms of pneumonia. Chest computed tomography (CT) imaging demonstrated new patchy ground glass infiltrates throughout the upper and lower lobes of the left lung, and the RSV direct fluorescence antibody (DFA) was positive. The patient received aerosolized ribavirin, one dose of intravenous immunoglobulin, and one dose of palivizumab. After two months of followup, the patient had improved infiltrates on chest CT, improved pulmonary function testing, and no evidence of graft rejection or dysfunction. There are few data on RSV infections in heart transplant patients, but this case highlights the importance of considering this potentially serious infection and introduces a novel method of treatment.

No MeSH data available.


Related in: MedlinePlus