Elsevier

Heart & Lung

Volume 38, Issue 6, November–December 2009, Pages 526-529
Heart & Lung

Case studies in infectious disease
Herpes simplex virus type-1 pneumonitis in immunocompetent young woman

https://doi.org/10.1016/j.hrtlng.2009.05.002Get rights and content

Abstract

A healthy young woman presented with an overwhelming hyperacute herpes simplex virus-1 pneumonia that dramatically responded to intravenous acyclovir. It is postulated that the infection was a reactivation of latent virus in the vagal ganglia, in the absence of retrograde extension of herpes labialis/gingivostomatitis, or hematogenous spread from extragenital and other sources of infection. It is also postulated that the patient's amazing improvement overnight was a real-time coincidence of spontaneous recovery from the viral infection and prompt initiation of acyclovir treatment.

Section snippets

Case Report

A 19-year-old woman with no known medical issues and working at a local restaurant experienced fever, cough, dyspnea, dizziness, and chest discomfort/pain that had been worsening for 2 days. The patient was referred to the emergency department. She was found to be hypoxic, admitted to the medical surgical floor, and immediately transferred to the intensive care unit. She was placed on biphasic positive airway pressure and intubated and sedated. Ceftriaxone, azithromycin, and sulfamethoxazole

Discussion

Some species of herpes virus, such as HSV-1 and HSV-2, herpesvirus-6, herpesvirus-8, varicella-zoster, and cytomegalovirus, can cause pneumonia. Varicella-zoster pneumonia is well known, fairly common, and seen in immunocompetent hosts. In contrast, HSV pneumonia, either type 1 or 2, is a rare occurrence and almost exclusively observed in immunocompromised hosts (eg, the elderly; bone marrow transplant recipients; and those with malnutrition, malignancy, burns, severe pulmonary disease, or

Conclusions

An otherwise healthy young woman manifested an overwhelming acute HSV-1 pneumonia that dramatically resolved with acyclovir. It is postulated that the patient was actually more ill than recognized, as indicated by the low protein and hyperglycemia, although malnutrition and diabetes mellitus were not observed during her care. What was the source of infection? A history of herpetic labialis or stomatitis was never proved, and cutaneous and genital vesicles were not found on her complete physical

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    The infection pattern in the current patient was considered to be reactivation because her anti-HSV1 IgG level was high,18 and she had experienced a herpes virus lip infection several years earlier. Acyclovir was generally selected for the treatment of HSV1P,6-14,19 except in two cases (Table 1). The study patient improved spontaneously with no medications,6 and a postmortem diagnosis of HSV1P was made in the other patient.

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    2017, Journal of the American Society of Cytopathology
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    Herpes simplex virus (HSV) infection of the respiratory tract can occur anywhere from the mouth to the alveoli,1 and both radiographic evaluation and bronchoscopy can be of value in identifying the site of infection.2 Patients with immunocompromised status, prolonged intubation,3 burns,4 and neoplasia5 are at increased risk for infection, but potentially anyone,6 including neonates and children7-9 is at risk.2 The presence of HSV in the lung may be associated with poorer clinical outcome.3

  • A patient with progressive dyspnea and multiple foci of airspace consolidation

    2014, Chest
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    This case is unique as herpes pneumonia is usually described in critically ill patients on mechanical ventilation,2,3 in burn patients,2 following open thoracic surgery,4,5 or in obviously immunocompromised hosts, where disseminated HSV infection is not uncommon.1 It is rarely seen in otherwise immunocompetent individuals where it is only described in case reports.6–9 Upon further discussion with the patient regarding the exact nature of his marijuana use, he informed us that he regularly uses a large-mouth glass pipe requiring deep inhalations and that he had a large, painful “cold sore” on his upper lip 3 to 4 weeks before the onset of his symptoms.

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    Herpes simplex virus pneumonia is seen almost exclusively in immunocompromised hosts. Although the symptoms are similar to those of CMV pneumonia, herpes simplex virus spreads from either extension or aspiration of the virus from an oral lesion or hematogenous spread from genital lesions.15 We are not told that this patient had any oral or genital lesions.

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