CHEST Guidelines-A-72-Year-Old-Woman-With-Respiratory-Failure-and-B (1)

A-72-Year-Old-Woman-With-Respiratory-Failure-and-B (1)

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This medical case study details the diagnosis and treatment of a 72-year-old Japanese woman with type 2 diabetes mellitus and hypertension, who was admitted to the hospital with symptoms of anorexia and dyspnea upon exertion. Initial diagnostic tests included chest radiograph and CT scan, revealing bilateral ground-glass opacities and patchy opacities in the lung fields. Laboratory tests ruled out common pneumonia pathogens. Despite an initial suspicion of acute interstitial pneumonia, further investigation via sputum cytology and bronchoscopy indicated the presence of intranuclear inclusion bodies typical of viral infection. Herpes simplex virus type 1 (HSV1) was confirmed through immunoperoxidase staining and polymerase chain reaction (PCR) testing of bronchial washing fluid. The patient was diagnosed with HSV1 pneumonia, a rare condition often seen in immunocompromised individuals, but in this case, it occurred in an individual without significant immunosuppression. Notably, she had no recent history of respiratory infections or medication changes.<br /><br />The patient was treated successfully with acyclovir, an antiviral medication, following the worsening of her respiratory condition despite initial corticosteroid and azithromycin treatment. The antiviral treatment led to significant improvement in her lung condition and the patient eventually recovered and remains relapse-free.<br /><br />This case highlights the possibility of HSV1 as a cause of community-acquired pneumonia, particularly in patients with manageable underlying conditions such as diabetes. It emphasizes the need for considering viral causes of pneumonia, proper sampling from the lower respiratory tract for accurate diagnosis, and caution in the use of corticosteroids in viral pneumonia cases. The report underscores the importance of differential diagnosis in pneumonia to differentiate between viral and other forms to avoid detrimental treatments and ensure effective patient management.

Keywords

HSV1 pneumonia

type 2 diabetes

hypertension

ground-glass opacities

viral infection

acyclovir treatment

community-acquired pneumonia

differential diagnosis

immunoperoxidase staining

polymerase chain reaction