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

A-72-Year-Old-Woman-With-Respiratory-Failure-and-B

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A 72-year-old woman with a history of type 2 diabetes mellitus and hypertension was admitted to the hospital due to shortness of breath and anorexia. She exhibited diffuse fine crackles, bilateral patchy opacities in the upper lung fields, and ground-glass opacities on chest CT. Initial treatment with prednisolone and azithromycin was ineffective, and her condition worsened. Upon finding intranuclear inclusion bodies in sputum, viral pneumonia was suspected. A bronchoscopy confirmed the presence of Herpes Simplex Virus type 1 (HSV1) in the bronchial washing fluid through PCR testing. Negative culture results for bacteria, fungi, and mycobacteria ruled out other infections, leading to a diagnosis of HSV1 pneumonia (HSV1P).<br /><br />HSV1P, although rare, especially in non-immunocompromised individuals, was confirmed in this patient, emphasizing the need to consider it in differential diagnoses. Previous studies indicate HSV1P is common among transplant recipients or those on immunosuppressants, with only limited cases reported in others.<br /><br />The patient was treated with acyclovir for 16 days, leading to an improvement in her condition and no relapse post-discharge. Unlike general expectations with HSV infections, no skin, oral, or genital lesions were observed.<br /><br />This case stresses the importance of considering viral pneumonia, such as HSV1P, even in patients without significant immune system compromise or classic symptoms. It also warns against the premature use of corticosteroids without ruling out viral causes. The findings underline the importance of comprehensive diagnostics, including bronchoscopy and PCR, when standard treatments fail and unusual pathogens are suspected. Understanding the atypical presentations and recovery outcomes of viral pneumonia like HSV1P can guide clinicians in managing similar cases effectively.

Keywords

HSV1 pneumonia

viral pneumonia

Herpes Simplex Virus

PCR testing

acyclovir treatment

bronchoscopy

immunocompromised

type 2 diabetes

differential diagnosis

ground-glass opacities