Which patients should be treated is still an individual decision based on the clinical context. Our patient showed clinical deterioration, respiratory impairment, and persistently elevated inflammation markers despite broad-spectrum antibiotic treatment.
We assumed underlying immunodeficiency due to his CLL, which was supported by evidence of reduced total immunoglobulin G levels 3. No bacterial pathogen could be isolated at any point. Given these circumstances, we interpreted HSV-1 detection as evidence of clinically relevant infection warranting antiviral therapy. Data for this special subset of patients in intensive care are thus scarce to date.
We highlight with this case that atypical and opportunistic infections, such as herpes viruses, should be liberally considered in patients with underlying disease. We would like to thank E. Schafroth, MD, head of our radiology department, for providing the radiologic image and M. Additional file 1: 29K, pdf Timeline. PDF 29 kb. All authors read and approved the final manuscript. As we did not use any new procedure or any treatment, which was not already approved for clinical use in our institution, we did not obtain approval by an ethics committee or consent to participate from the patient beforehand.
Written informed consent was obtained from the patient for publication of this case report and any accompanying images. A copy of the written consent is available for review by the Editor-in-Chief of this journal. Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Electronic supplementary material. Miriam Luginbuehl, Email: moc. Alexander Imhof, Email: hc. Alexander Klarer, Email: hc. National Center for Biotechnology Information , U. J Med Case Rep. Published online Nov Author information Article notes Copyright and License information Disclaimer.
Corresponding author. Received Apr 29; Accepted Oct This article has been cited by other articles in PMC. Associated Data Data Availability Statement The dataset used and analyzed during the current study is available from the corresponding author on reasonable request. Abstract Background Pulmonary pathogenicity of herpes simplex virus type 1 in patients in intensive care without classic immunosuppression as well as the necessity of antiviral treatment in the case of herpes simplex virus detection in respiratory specimens in these patients is controversial.
Case presentation A year-old white man presented with symptoms of lower respiratory tract infection. Conclusions Herpes simplex virus should be considered a cause for lower respiratory tract infection in critically ill patients, especially in the setting of an underlying disease. Electronic supplementary material The online version of this article doi Keywords: Herpes simplex virus, Pneumonia, Acute respiratory distress syndrome, Case report. Background Primary herpes simplex virus type 1 HSV-1 infection occurs after viral inoculation at mucosal or skin surfaces.
Keywords: critically ill patients; herpes simplex virus pneumonia; immunocompromised; intensive care unit. Abstract Background: Pneumonia due to herpes simplex virus HSV is uncommon but can be seen in immunocompromised patients and has been associated with poor prognosis in this population. Publication types Review.
We must realize again the importance of oral care for hospitalized patients to avoid aspiration pneumonia, including herpetic pneumonia. Abstract Herpes simplex virus HSV pneumonia caused by aspiration from the oropharyngeal exudates is described. Publication types Case Reports. Areas of ground-glass attenuation are the most common HRCT finding in adult viral pneumonia including cytomegalovirus, influenza virus, varicella-zoster virus and adenovirus, and correspond histopathologically to areas of diffuse alveolar damage [ 8 , 9 ].
Our study has several limitations. Its first and major limitation was that the sample size was small, which was mainly due to a difficulty in a specific confirmative diagnosis of viral pneumonia.
However, HSV pneumonia can be confidently diagnosed based on the presence of positive intranuclear inclusion bodies on haematoxylin and eosin staining or positive immunohistochemical staining for HSV [ 5 ]. In conclusion, three HRCT patterns of pulmonary abnormalities were identified in our series of HSV pneumonia: predominant areas of diffuse or multifocal ground-glass attenuation, predominant areas of peribronchial consolidation and a mixed pattern of both.
No specific differences in HRCT findings were seen between the immunocompromised and immunocompetent patients. National Center for Biotechnology Information , U. Journal List Br J Radiol v. Br J Radiol. Author information Article notes Copyright and License information Disclaimer. E-mail: moc. This article has been cited by other articles in PMC. Abstract The purpose of this study was to evaluate the high-resolution computed tomographic HRCT findings of five adult patients either immunocompromised or immunocompetent with herpes simplex virus HSV pneumonia.
Open in a separate window. Figure 1. Figure 4. Table 1 High-resolution CT findings of five patients with herpes simplex virus pneumonia. Figure 2. Figure 3.
References 1. Herpes simplex virus 1 pneumonia: patterns on CT scans and conventional chest radiographs. Herpes simplex virus type 2 pneumonia after bone marrow transplantation: high-resolution CT findings in 3 patients.
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