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Herpes Simplex Pneumonia in an Immunocompetent Patient With Progression to Organizing Pneumonia.

Mills B, Ratra A, El-Bakush A, Kambali S, Nugent K - J Investig Med High Impact Case Rep (2014)

Bottom Line: Most cases are idiopathic, but some are associated with infections.Discussion.To our knowledge this is only the second reported case associated with HSV.

View Article: PubMed Central - PubMed

Affiliation: Texas Tech University Health Sciences Center, Lubbock, TX, USA.

ABSTRACT
Background. Organizing pneumonia is an uncommon diffuse interstitial lung disease that affects the terminal and respiratory bronchioles, alveolar ducts, and alveoli. Most cases are idiopathic, but some are associated with infections. We present an uncommon case of organizing pneumonia associated with herpes simplex virus-1 (HSV-1). Case. A 39-year-old man with hypertension presented with dyspnea, fever, and productive cough for 2 weeks. He was treated for 5 days for acute bronchitis as an outpatient with no improvement. His examination revealed mild respiratory distress, O2 saturation 92% on room air, and right sided crackles. Labs included a white blood cell count of 19 300/µL. His chest x-ray showed bilateral infiltrates greater on the right. Bronchoalveolar lavage was positive for HSV-1; transbronchial biopsies showed focal pneumonitis with plentiful intra-alveolar macrophages. His respiratory status progressively deteriorated, and he was intubated for mechanical ventilation. He received 10 days of intravenous (IV) antibiotics and 14 days of IV acyclovir. He was readmitted 10 days later with worsening symptoms and was intubated for respiratory failure. His CT chest showed diffuse, patchy consolidation of both lungs, right more than left. Open lung biopsy showed extensive organizing pneumonia, diffuse alveolar damage, intra-alveolar macrophages, and pleural fibrosis; he was treated with IV corticosteroids. He was extubated after 10 days; within 2 weeks his chest x-ray was markedly improved. Discussion. Organizing pneumonia is usually idiopathic; infection is one of the secondary causes. To our knowledge this is only the second reported case associated with HSV. This association may have important pathogenic and therapeutic implications.

No MeSH data available.


Related in: MedlinePlus

Day of open lung biopsy. Bilateral diffuse infiltrates.
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fig2-2324709614530560: Day of open lung biopsy. Bilateral diffuse infiltrates.

Mentions: Twelve days after discharge, the patient returned with increasing shortness of breath and bloody sputum for the previous 3 days. His vital signs were as follows: blood pressure 142/91 mm Hg, heart rate 99 beats per minute, and respiratory rate 24 breaths/min. His physical examination was significant for decreased breath sounds especially on the right side and bilateral crackles with occasional wheezing. His labs were as follows: WBC 13,300/µL, hemoglobin 11.3 g/dL, hematocrit 35.4%, sodium 140 mmol/L, potassium 3.2 mmol/L, BUN 8 mg/dL, creatinine 0.8 mg/dL, glucose 117 mg/dL, total bilirubin 1.6 mg/dL, albumin 3.7 g/dL, ALT 23 IU/L, AST 17 IU/L. Cardiac enzymes were negative. A chest CT showed worsening consolidation of the lungs bilaterally, especially in the right lung. Sputum and blood cultures were negative. He was started on vancomycin 2 g 3 times daily, azithromycin 500 mg once daily, cefepime 1 g 3 times daily, and acyclovir 1.2 g 3 times daily but showed little improvement. He was intubated 4 days after admission for a total of 21 days (Figure 2). Ten days after admission he had an open lung right wedge biopsy that showed organizing pneumonia changes with interstitial pneumonitis (Figures 3 and 4). Pathology also showed diffuse alveolar damage with hyaline membranes, intra-alveolar macrophages, and pleural fibrosis. He was started on methylprednisolone 40 mg 4 times daily over the next 14 days and his oxygenation improved. Three days after extubation the patient left against medical advice (AMA). He presented in the internal medicine clinic for a follow-up appointment where he stated that he was admitted to a different hospital the same day he left AMA. He stayed at the other hospital for 2 weeks and was continued on prednisone. At the clinic he reported a cough but no dyspnea or limitations of activity. He was off prednisone.


Herpes Simplex Pneumonia in an Immunocompetent Patient With Progression to Organizing Pneumonia.

Mills B, Ratra A, El-Bakush A, Kambali S, Nugent K - J Investig Med High Impact Case Rep (2014)

Day of open lung biopsy. Bilateral diffuse infiltrates.
© Copyright Policy - creative-commons
Related In: Results  -  Collection

License 1 - License 2 - License 3
Show All Figures
getmorefigures.php?uid=PMC4528890&req=5

fig2-2324709614530560: Day of open lung biopsy. Bilateral diffuse infiltrates.
Mentions: Twelve days after discharge, the patient returned with increasing shortness of breath and bloody sputum for the previous 3 days. His vital signs were as follows: blood pressure 142/91 mm Hg, heart rate 99 beats per minute, and respiratory rate 24 breaths/min. His physical examination was significant for decreased breath sounds especially on the right side and bilateral crackles with occasional wheezing. His labs were as follows: WBC 13,300/µL, hemoglobin 11.3 g/dL, hematocrit 35.4%, sodium 140 mmol/L, potassium 3.2 mmol/L, BUN 8 mg/dL, creatinine 0.8 mg/dL, glucose 117 mg/dL, total bilirubin 1.6 mg/dL, albumin 3.7 g/dL, ALT 23 IU/L, AST 17 IU/L. Cardiac enzymes were negative. A chest CT showed worsening consolidation of the lungs bilaterally, especially in the right lung. Sputum and blood cultures were negative. He was started on vancomycin 2 g 3 times daily, azithromycin 500 mg once daily, cefepime 1 g 3 times daily, and acyclovir 1.2 g 3 times daily but showed little improvement. He was intubated 4 days after admission for a total of 21 days (Figure 2). Ten days after admission he had an open lung right wedge biopsy that showed organizing pneumonia changes with interstitial pneumonitis (Figures 3 and 4). Pathology also showed diffuse alveolar damage with hyaline membranes, intra-alveolar macrophages, and pleural fibrosis. He was started on methylprednisolone 40 mg 4 times daily over the next 14 days and his oxygenation improved. Three days after extubation the patient left against medical advice (AMA). He presented in the internal medicine clinic for a follow-up appointment where he stated that he was admitted to a different hospital the same day he left AMA. He stayed at the other hospital for 2 weeks and was continued on prednisone. At the clinic he reported a cough but no dyspnea or limitations of activity. He was off prednisone.

Bottom Line: Most cases are idiopathic, but some are associated with infections.Discussion.To our knowledge this is only the second reported case associated with HSV.

View Article: PubMed Central - PubMed

Affiliation: Texas Tech University Health Sciences Center, Lubbock, TX, USA.

ABSTRACT
Background. Organizing pneumonia is an uncommon diffuse interstitial lung disease that affects the terminal and respiratory bronchioles, alveolar ducts, and alveoli. Most cases are idiopathic, but some are associated with infections. We present an uncommon case of organizing pneumonia associated with herpes simplex virus-1 (HSV-1). Case. A 39-year-old man with hypertension presented with dyspnea, fever, and productive cough for 2 weeks. He was treated for 5 days for acute bronchitis as an outpatient with no improvement. His examination revealed mild respiratory distress, O2 saturation 92% on room air, and right sided crackles. Labs included a white blood cell count of 19 300/µL. His chest x-ray showed bilateral infiltrates greater on the right. Bronchoalveolar lavage was positive for HSV-1; transbronchial biopsies showed focal pneumonitis with plentiful intra-alveolar macrophages. His respiratory status progressively deteriorated, and he was intubated for mechanical ventilation. He received 10 days of intravenous (IV) antibiotics and 14 days of IV acyclovir. He was readmitted 10 days later with worsening symptoms and was intubated for respiratory failure. His CT chest showed diffuse, patchy consolidation of both lungs, right more than left. Open lung biopsy showed extensive organizing pneumonia, diffuse alveolar damage, intra-alveolar macrophages, and pleural fibrosis; he was treated with IV corticosteroids. He was extubated after 10 days; within 2 weeks his chest x-ray was markedly improved. Discussion. Organizing pneumonia is usually idiopathic; infection is one of the secondary causes. To our knowledge this is only the second reported case associated with HSV. This association may have important pathogenic and therapeutic implications.

No MeSH data available.


Related in: MedlinePlus