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Successful Treatment of Severe Adenovirus Pneumonia With Cidofovir in a Lung Transplant Recipient FREE TO VIEW

Mohammed Al Faiyumi, MD; Alan Betensley, MD
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Henry Ford Hospital, Detroit, MI

Chest. 2013;144(4_MeetingAbstracts):172A. doi:10.1378/chest.1704546
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SESSION TITLE: Infectious Disease Case Report Posters I

SESSION TYPE: Affiliate Case Report Poster

PRESENTED ON: Tuesday, October 29, 2013 at 01:30 PM - 02:30 PM

INTRODUCTION: Adenovirus is a cause of mild upper respiratory tract infection in the immunocompetent host. It is known to cause severe disseminated disease in the immunocompromised host. Little is known about the natural history and treatment of this viral infection in lung transplant patients. In this report we describe the successful treatment of severe adenovirus pneumonia with Cidofovir in a lung transplant recipient

CASE PRESENTATION: We describe the case of a 53 year-old woman who underwent bilateral lung transplantation for pulmonary fibrosis associated with rheumatoid arthritis. She was relatively well after her transplant - with only one episode of A2B2 rejection that was treated with a steroid burst - until three years after her transplantation when she developed bronchiolitis obliterans syndrome and had multiple hospitalization with respiratory problems (pneumonia, bronchial stenosis requiring stenting, respiratory distress). She presented to the hospital again with shortness of breath, cough and new pulmonary infiltrate. She required ICU hospitalization and was started empirically on broad spectrum antibiotics. Bronchoscopy was done after which she developed hypercapnic respiratory requiring endotracheal intubation and mechanical ventilation. Adenovirus was isolated for BAL and this was initially treated by decreasing her immunosuppression to only steroids. Her respiratory status continued to worsen with worsening airway obstruction as evident by rising peak airway pressure (65-75 cm H2O), air trapping (autopeep 10-15 cm H2O) and worsening hypercapnia with respiratory acidosis. This was accompanied by acute kidney injury secondary to acute tubular necrosis which required initiation of renal replacement therapy. Cidofovir therapy was initiated at this point. She was treated with a total dose of 5 mg/kg weekly for three weeks. This resulted in significant clinical improvement with resolution of airway obstruction (decreasing peak airway pressure, resolving autopeep and improving hypercapnia). The patient was successfully extubated 12 days later to NIPPV and then to nasal cannula afterwards.

DISCUSSION: No antiviral drug has been approved for the treatment of adenovirus infection. Cidofovir, a cytosine nucleotide analogue that inhibits DNA polymerase, has the greatest in vitro activity against Adenovirus amongst the currently available antiviral agents. No randomized trial has been performed to assess its efficacy and safety but multiple small case series have demonstrated it efficacy in other immunocompromised hosts

CONCLUSIONS: Cidofovir seems to be a viable for treating adenovirus pneumonia in lung transplant recipients.

Reference #1: Treatment of adenovirus pneumonia with cidofovir in pediatric lung transplant recipients. Doan ML, Mallory GB, Kaplan SL, Dishop MK, Schecter MG, McKenzie ED, Heinle JS, Elidemir O. J Heart Lung Transplant. 2007 Sep;26(9):883-9.

DISCLOSURE: The following authors have nothing to disclose: Mohammed Al Faiyumi, Alan Betensley

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